ORAL ANSWERS TO QUESTIONS

ENERGY AND CLIMATE CHANGE

The Secretary of State was asked—

Energy Efficiency

Iain McKenzie: What steps he is taking to help households improve their energy efficiency.

Edward Davey: Before I answer may I, on behalf of many Members of the House, welcome the election of the new pope, Pope Francis?
	The green deal, which went fully live on Monday 28 January, will help transform the homes of British people over the coming decade and beyond. This transformational policy, along with the energy company obligation and the roll-out of smart meters, will drive the development of a new energy efficiency market, providing unprecedented choice, benefits and access to low-cost finance for British households.

Iain McKenzie: The Government claim that the green deal will be the biggest and best home improvement plan since the second world war. Can the Minister tell us how many households have taken out the green deal so far?

Edward Davey: The green deal has got off to an excellent start. As the hon. Gentleman may know, we have released data today which show that nearly 2,000 green deal assessments have been made, and already that figure is out of date. There are more than 600 accredited advisers and more than 600 installing firms have been accredited. Nearly £30 million of ecos have been traded on eco-brokerage. The hon. Gentleman should listen to the industry. I do not often recommend that people listen to tweets, but if he looks at the tweets of British Gas, GHE Solar, Toriga and Green Deal Shop, they will tell him and other right hon. and hon. Members how well those firms are doing with assessments and, they believe, taking those on to installations.

Stephen Mosley: It is estimated that 8 million homes would benefit from solid wall insulation and 4 million from cavity insulation. There is
	a huge market out there for the green deal. What is my right hon. Friend doing to promote the green deal to make sure that as many people as possible take it up?

Edward Davey: I can assure my hon. Friend that I, my Ministers, the whole Department and the whole Government are pushing the green deal. The solid walls that he referred to—those 8 million homes—have not featured in energy efficiency programmes in any major way before. It has been an undealt-with issue in energy efficiency. We have not ducked that and we are tackling it.

Luciana Berger: It is just over a month since the green deal was launched. We have just heard that more than 2,000 assessments have taken place. However, the Secretary of State refuses to reveal how many households have actually signed for a green deal package. We know that the Department is monitoring green deal uptake in real time through the energy performance certificate register. Why will he not share that information with the House today?

Edward Davey: I am surprised that the hon. Lady has asked that question as it suggests that she does not understand how the green deal plans work. She should know, and I think she probably does, that after an assessment has been made and an installation programme has been booked, the green deal plan is signed only after the installation has been completed and then goes on to the green deal register for the green deal payments to appear on the bill. So there is quite a lag, as the hon. Lady would know. We did not expect a huge number of green deal plans to have already been signed. The key issue at this stage is the green deal assessments and the green deal assessors, and we are making huge progress, as the industry is saying.

Luciana Berger: I thank the Secretary of State for that response, but he will know that the public want to know how many people, having seen their assessment, have signed on the dotted line for the deal. Given that Nationwide is offering energy efficiency loans with an interest rate of just 2.29%—less than a third of the interest rate under the green deal—does the Secretary of State believe that more people would take out the green deal if offered a better deal?

Edward Davey: The green deal is going well, as the industry says. I welcome Nationwide’s product because it shows that there is more competition in the market. It shows what the green deal is spurring. It is not just green deal plans that will be a mark of the programme’s success; it is green deal self-funded plans, which will be a result of the green deal assessments being made. They would not be made in the way that they are if we had not gone forward, and the hon. Lady should welcome that.

Philip Hollobone: Domestic LED lighting can use as little as 5% of the power of a normal light bulb. Though more expensive initially to buy, LED light bulbs require very little maintenance and have a very long life. What incentives are there in the green deal or elsewhere to promote domestic LED lighting?

Edward Davey: My hon. Friend makes an important point. We strongly support LED lighting. There are issues about whether different types of lighting can
	come under the green deal because light bulbs can be taken away, and if the cost of those is in the electricity meter for the next tenant or the next owner-occupier, that would not be fair and would not, therefore, abide by the green deal rules. But we agree with my hon. Friend—there is a strong case for people investing in LED.

Deep-mine Coal Industry

Ian Lavery: What assessment he has made of the future of the deep-mine coal industry in the UK.

John Hayes: The Government value the role of British coal in meeting our energy needs. Equipped with carbon capture and storage, coal generation can continue to play a significant long-term role as part of a future low-carbon energy mix.

Ian Lavery: The Minister is very much aware of the situation at Daw Mill colliery, where 650 miners who have given their lives to the coal mining industry are facing uncertainty with regard to redundancy payments. Will he give a commitment to do everything in his power to ensure that these men receive their entitlements in full?

John Hayes: There are few in this House who can match the hon. Gentleman’s understanding, knowledge and support for the coal industry. I cannot match it, but what I can match is his determination to do right by the workers there. I had a positive meeting with the unions yesterday; I also met UK Coal yesterday and, again, had a positive meeting. The Government will do all they can, not only to protect the future of the coal industry, but to protect the interests of those workers who will lose their jobs at Daw Mill. I made that abundantly clear. We cannot match the hon. Gentleman’s knowledge of these things, but I can certainly match his determination.

David Mowat: The Minister said in his response that coal had a good future in this country if it was combined with carbon capture and storage, a technology that is many years from working. Across the rest of the world, unabated coal is accelerating. In particular, countries such as Germany that produce 20% more carbon per unit of GDP and 20% more carbon per capita than us are launching a number of coal-fired stations. Why is their position so different from ours?

John Hayes: We are committed to CCS because we believe it can work. My hon. Friend will know that the carbon capture and storage cost reduction taskforce predicted it could work much earlier than previously estimated—by the early 2020s. With carbon capture and storage, coal can play an important part in our future. I cannot be clearer than that, Mr Speaker, surely.

Dennis Skinner: The Minister will be aware that UK Coal, which owns Daw Mill colliery, is one of the principal owners in the coal industry that remains. The worst case scenario that we had put to us the other day was that if UK Coal cannot
	survive, two more pits—one that is loss making, one that is making a bob or two—could go, as well as some other land sites. When he is talking about Daw Mill colliery and talking to UK Coal, will he ensure that he protects the redundancy money? There is someone in my constituency who used to work in Derbyshire but who now travels 100 miles there and back to Daw Mill. Will he get his redundancy pay? He was finished before the fire, so will the Minister get on with it?

John Hayes: The hon. Gentleman is absolutely right—again, he is an authority on these matters. The pits at Thoresby and Kellingley are, of course, also owned by Daw Mill. Part of our determination—the determination I outlined a moment ago—is to ensure that the future of those pits is secured. However, he is also right to say—this goes for me, too—that the workers matter most in all this. That includes the workers who were made redundant in the early restructuring, the workers at Thoresby and Kellingley and the workers at Daw Mill. I have made that abundantly clear to the unions, with which I had such a positive meeting, and I have told the company that, for the Government, it is a key priority.

Tom Greatrex: The Minister has already referred to the importance of CCS in relation to the medium and long-term future of coal generation. I am sure he will be aware that around two thirds of the coal we burn to generate electricity in the UK is imported. He might not be aware yet that, as of 9.5 this morning, 46% of all the electricity being generated in Britain today is from coal-fired stations. Given those two factors and his determination, as he has said in the past, to put the “coal” into coalition, may I urge him to put the “sense” into sensible and get on with developing a short-term strategy for coal to protect the indigenous industry in the UK?

John Hayes: That is a good point. There is a good argument for making a clear statement about how we see coal developing in the short to medium term. It is absolutely right that we pursue CCS. Perhaps we will get the chance to say more about that later in these questions—who knows, Mr Speaker? The hon. Gentleman is right, and I will certainly consider making a statement on that. The appropriate time for that will be when we make further progress at Daw Mill, Thoresby and Kellingley. He is right. The Government can learn from the Opposition, and the wise Ministers on the Front Bench recognise that.

Electricity Infrastructure

John Pugh: What recent discussions he has had with utility companies on the cost of providing electricity infrastructure.

John Hayes: rose—

Mr Speaker: I think that the Minister is recovering from his last witticism.

John Hayes: It is as though all my Christmases have come at once, Mr Speaker.
	My regular discussions with energy companies about the cost of our electricity infrastructure are essential to ensure that the Government guarantee energy security, meet decarbonisation objectives and, just as important, do so in a way that makes energy affordable for customers across Britain.

John Pugh: I thank the Minister for that answer. He will be aware that, as a result of statutory undertakings, companies such as ScottishPower have a virtual monopoly over electricity industry infrastructure, which hinders commercial development, particularly in my constituency. What can be done about that?

John Hayes: Let me be clear that my Department expects network companies to provide connections in a timely and affordable way while maintaining the secure electricity on which we have all come to depend. Connections to the distribution network are a matter for the distribution network operator, as my hon. Friend knows, and the independent regulator, Ofgem. I entirely agree that those companies must behave properly, as we make extremely clear in our discussions with them. Indeed, I was with a number of transmission companies earlier this week doing just that.

Andy Sawford: Bloomberg research has shown that investment in renewable energy has halved since this Government came to power, and the Pew group has found that Britain has slipped to seventh in the world for investment in clean energy, so is it not the case that, although the Government talk a good game, we are actually slipping behind in investment?

John Hayes: That is an interesting tangential question, given the question on the Order Paper, but the hon. Gentleman is absolutely right that it is vital to our energy security that we have an energy mix. Our Energy Bill underpins exactly that strategy—a mixed economy of generation—purely because only by that means can we be sufficiently flexible and responsive in a highly dynamic set of circumstances.

Tim Yeo: Does my hon. Friend agree that it is very important to avoid incurring costs by building infrastructure that is not needed? Is he aware that the National Grid proposal to construct overhead pylons across Suffolk was based on the assumption of early completion of new nuclear power stations at Sizewell and completion of a large number of offshore wind farms, none of which is certain to be built? Does he agree, therefore, that the proposal should now be deferred?

John Hayes: It is right that the infrastructure we put in place should meet a purpose; infrastructure without a purpose can hardly be legitimised. I am not as familiar with the intimate details of the affairs of Suffolk as my hon. Friend is; he would hardly expect me to be, but I am more than happy to take a look at that. Furthermore, and not for the first time, I would be delighted to meet him to discuss these matters more fully.

Michael Weir: In his discussions on infrastructure, has the Minister considered the place of pump storage systems and how they fit into the new world of contracts for difference and capacity payments?

John Hayes: It is not the first time the hon. Gentleman has raised that matter. Scotland has a particular interest in that, because of the transmission circumstances that prevail there. That is something the Department has looked at and we continue to have those kinds of exploratory discussions. If he wants to feed into those, of course his contribution, as ever, would be most welcome.

Green Deal

Robin Walker: What recent progress he has made on the roll-out of the green deal.

Jeremy Lefroy: What recent progress he has made on the roll-out of the green deal.

Gregory Barker: The green deal went live, on time, on Monday 28 January. The Government’s “Green Deal With It” communications campaign was launched the same day. By the end of February, according to the official statistics, 1,803 assessments had been carried out.

Robin Walker: I am grateful to the Minister for that answer. Major employers in Worcester, such as Wolseley, npower and Worcester Bosch, are looking forward to participating in the green deal, but the latter warned that for the programme to reach its full potential more ordinary installers need to be given the chance to sell it. What steps are the Government taking to reach out to installers and ensure that they have a chance to play a part in rolling out the green deal?

Gregory Barker: A whole range of installers will be absolutely vital, and I was delighted to see that Wolseley has said that it is seeing strong demand not only for its products, but for adviser training, as it is a trainer. For small and medium-sized enterprises, we are waiving all fees and oversight costs for the first two years. We are hosting a range of networking events with the Federation of Small Businesses, the British Chambers of Commerce and the CBI, and we are co-hosting eco roadshows with Energy UK. We are also committing money to training assessors and installers, and there is more to come.

Jeremy Lefroy: Stafford borough council is working with green deal providers to raise awareness among my constituents of access to the scheme. Will the Minister and his green deal team meet me and the council to discuss how we can encourage the best possible take-up in Stafford and the surrounding areas?

Gregory Barker: I would be delighted to meet my hon. Friend and his council. We are seeing a very encouraging degree of not only commitment but real enthusiasm from local authorities across the country. Local authorities will be key to a really ambitious roll-out.

David Hanson: Will the Minister reflect a little further on the question that my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) put to the Secretary of State—namely, are the
	interest rates for the green deal too high to encourage take-up and ultimately too high for consumers to get a good deal out of the green deal?

Gregory Barker: I understand what lies behind this point. However, if the right hon. Gentleman looks at this carefully, he will see that when people quote interest rates such as the one for Nationwide they are not comparing like with like. Crucially, the green deal interest rate is fixed for 20 years. I am aware of only one other such product in the market. Access to the green deal interest rate is incredibly fair and open, and not only for people who are lucky enough to own their own homes.

Andrew Gwynne: The Minister’s answer just will not do, because the blunt truth is that the green deal interest rate is set at almost 7%. Is it not the case that many people who take up the green deal will find that interest repayments end up costing more than the original measures, and, worse still, that if they try to repay their loan early they will be clobbered with hefty fines? How is that fair?

Gregory Barker: I will tell the hon. Gentleman what is not fair: scaremongering about the green deal, particularly when that puts off vulnerable people who would otherwise have no access to affordable finance. [Interruption.] The hon. Gentleman can scoff at 7%, but he should compare that to any other form of unsecured lending that is available to people on low wages or the minimum wage. How many people on low incomes, or people who are not lucky enough to be a home owner, can access interest rates like that? He might be a smart home owner himself, but he should think about those who do not have the same opportunities. This actually represents a really good deal.

Energy Bills

Dominic Raab: What steps he is taking to reduce energy bills.

Mark Lazarowicz: What steps he is taking to help households with their energy bills.

Edward Davey: We have a range of initiatives to help people with their energy bills, including tariff reforms, energy saving programmes, and additional help for those on the lowest incomes. From our proposals to help get consumers on the cheapest tariffs to the green deal, from the warm home discount to our promotion of collective switching, this Government are working to help people keep their energy bills down.

Dominic Raab: I thank the Secretary of State for that answer. However, supply is also crucial. Ofgem forecasts that UK spare electricity capacity will slump to 4% by 2015, and that highlights the acute need to get more nuclear power on stream. May I urge him to strain every sinew to finalise the right deal with EDF to build a new nuclear power station at Hinkley Point?

Edward Davey: I assure my hon. Friend that we are straining every sinew in the negotiations with EDF. He will recognise that I cannot be more explicit than that
	given that they are commercial negotiations. I will say, though, that we take energy security very seriously and listen to Ofgem, National Grid and others. However, we do not imagine that new nuclear power will assist in the rest of this decade, because new nuclear power stations take such a long time to build.

Mark Lazarowicz: We are currently going through a cold spell and, as night follows day, we know that in a few months’ time the energy companies will announce even bigger boosts in profits because people have been using more energy. Is it not time to get to a situation whereby a cold spell is not an occasion for energy companies to make even more profits but to keep prices down for consumers?

Edward Davey: The hon. Gentleman will know that we have taken a lot of extra powers in the Energy Bill to make sure that Ofgem’s reforms on tariffs can go through and that the energy companies cannot be allowed to drag their feet. That has been welcomed by many consumer groups. This Government have also taken action to help people on the lowest incomes. We have trebled cold weather payments, so when there is a cold snap people get the help they need when they need it.

Chris Heaton-Harris: When the House of Commons analysed the DECC-produced fuel poverty data set of 2009, the figures suggested that the renewables obligation could have pushed 100,000 people into fuel poverty, in 40,000 to 50,000 cases because of the wind element. How many people were pushed into fuel poverty last year because of expensive wind energy?

Edward Davey: I congratulate my hon. Friend on his ingenuity, but the analysis that others have done of those figures shows that what has really pushed people into fuel poverty has been gas prices, with global gas prices having increased significantly. We also have to deal with the renewal of the transmission mechanism and distribution networks. Those things have far bigger impacts on prices and bills. The hon. Gentleman ought to have a balanced approach.

Caroline Flint: The single biggest driver of rising energy bills is global gas prices. Last week the Institute for Public Policy Research think tank found that household energy bills would be lower and less volatile if the Government decarbonised the power sector by 2030. Does the Secretary of State agree?

Edward Davey: I strongly agree that a lot of analysis suggests that if we move to a decarbonised sector, this country and our consumers, people and firms will be less exposed to volatile international gas prices.

Caroline Flint: Although the Secretary of State says he agrees, the problem is that the Government are not tackling the issue. The truth is that the Energy Bill does not require the Government to set a decarbonisation target. Even if such a target was set, there is nothing under the Bill’s present arrangements to ensure that it would be met. The Committee on Climate Change is absolutely clear: the Government should set a decarbonisation target now, not in 2016, and all the Government are doing is extending the uncertainty for another two years. Was not the former Energy Minister,
	the hon. Member for Wealden (Charles Hendry), right when he said that this uncertainty will lead to higher capital costs and, ultimately, higher energy bills for the public?

Edward Davey: I have to remind the right hon. Lady and the House that no single party—not the Labour party, the Conservative party, the Liberal Democrats or even the Green party—argued in its 2010 manifesto for a decarbonisation target for the power sector. It was this Government and me as Secretary of State who argued for such a target and got the power to set one in the Energy Bill. When it comes to targets and having the policies to meet them, this Government have done far more than the previous one. The previous Government were right to set targets in the Climate Change Act 2008, but they did not produce the policies to meet them. This Government are.

Biomass Conversion

Nick Harvey: What recent assessment he has made of the long-term environmental effects of Government support for large-scale biomass conversion.

Gregory Barker: We agree that effective sustainability controls must be in place for bioenergy. We already have biomass sustainability criteria for the renewables obligation, and we now propose to improve them by adding new sustainable forest management criteria for wood fuel and a requirement for an independent audit, and by setting a trajectory so that greenhouse gas life-cycle savings targets become tougher over time.

Nick Harvey: I welcome the commitment to reforestry targets, but how do Ministers stand up the rather curious proposition that wood burning is carbon neutral? They support the conversion of coal-fired stations to wood burning, but that is only carbon neutral if emission at the point of burn is ignored, and it takes up to 98 years for tree growth to neutralise that. Will the Minister confirm that this dubious practice is simply an interim measure? I understand the need to protect the investment at Drax and elsewhere?

Gregory Barker: Biomass certainly needs to be sustainable as well as affordable, but it is not carbon neutral. However, I can tell the hon. Gentleman that greenhouse gas savings from biomass are at least 68% less than those for coal. Although it may not be carbon neutral, it is certainly much cleaner so far as carbon is concerned.

Barry Gardiner: A number of recent papers—the Searchinger paper, the Hudiburg paper and the Schulze paper—have noted the problems of life-cycle biomass. The Minister is right to have taken steps to address that in forest regrowth and the sustainability standards, but he has not yet addressed the impoverishment of soils and how the resulting increase in the use of fertiliser will lead to an increase in emissions. Will he publish the basis on which he amended his Department’s projections on biomass?

Gregory Barker: The hon. Gentleman makes a sensible point. He is right to highlight the impacts not just on the burning of wood or biomass, but on indirect land-use
	change. The Government are taking this seriously and we are working on it with colleagues at the Department for Transport. In order to be effective, land-use change needs to be dealt with on a pan-European basis. We would welcome support from throughout the House for work with our partners in Europe to put in place robust sustainability criteria.

Mr Speaker: We really must move on. We have a lot of progress to make.

Nigel Adams: Is the Minister fully committed—by which I mean not just words, but urgent action—to biomass of coal-fired power stations, such as Drax and Eggborough in my constituency, to biomass, which is sustainable?

Gregory Barker: The Minister of State, Department of Energy and Climate Change, my hon. Friend the Member for South Holland and The Deepings (Mr Hayes) met representatives of Eggborough this week and I can confirm that we are committed. As I have said, biomass conversion needs to be sustainable and affordable, and it is an important part of a balanced mix of clean technologies.

Plutonium Reuse (Sellafield)

Christopher Pincher: What assessment he has made of the Nuclear Decommissioning Authority’s process and timetable for determining credible options for plutonium reuse at Sellafield; and if he will make a statement.

John Hayes: The process and timetable on the reuse of plutonium were set out in the Government’s consultation response in December 2011. Work on the reuse of plutonium as a mixed oxide fuel is progressing well and remains on track.

Christopher Pincher: May I register my disappointment that the Minister has been forced to come to answer questions this morning, when as late as last night, some of us still held out the hope that he might be translated to the Holy See? Be that as it may, does he share my belief that the Nuclear Decommissioning Authority needs to ensure that more than one technology, not just CANDU, is deemed credible for plutonium reuse, so that any subsequent licensing round is competitive and transparent, and delivers best value for the British taxpayer?

John Hayes: I was always an outsider for Pope, although my infallibility was a strength. My hon. Friend is right that the licensing round needs to take account of those considerations. Following extensive discussions and consultation, we settled on making MOX for nuclear reactors our preferred policy option. However, the Nuclear Decommissioning Authority is still working on alternatives. We are finalising guidance on regulatory justification for the reuse of plutonium, and I can commit today that that will be published shortly.

Mr Speaker: Whether the Minister of State is infallible is a matter for conjecture, but in the 30 years that I have known him, he has always been inimitable.

Independent Power Generators

Alan Whitehead: What recent representations he has received on a future route to market for independent power generators.

John Hayes: Since our call for evidence last year, Ministers and officials have held meetings with a wide range of independent generators, suppliers and other stakeholders covering route-to-market issues, including the availability of power purchase agreements.

Alan Whitehead: Does the Minister recognise the difficulties that independent low-carbon generators will have with the passing of power purchase agreements following the end of the renewables obligation? Is he looking at alternatives to PPAs, such as the green power auction market, and will he seek to implement such a market in consideration of the Energy Bill?

John Hayes: The hon. Gentleman has been consistent in his advocacy of independent generators. He raised this issue during the Committee stage of the Energy Bill. He knows that I am not unsympathetic to his assertions about the difficulties that independent generators face. I believe that contracts for difference will make it easier for independent generators to access the market, as he knows, because they will remove wholesale price risk and eliminate the requirement to market renewables obligation certificates, which will also reduce risk. I make this commitment: I think that we need to look at this matter more closely and to do more. We need a more plural and a more liquid market to create competition and drive down prices.

Wind Farms (North Lincolnshire)

Edward Leigh: What the height will be of the proposed wind farms in north Lincolnshire; and if he will make a statement.

Edward Davey: The proposed height of wind turbines is set out in the planning applications that are submitted for proposed wind farms. The local planning portal shows four wind farms with applications submitted in north Lincolnshire, with heights that vary from up to 100 metres to 126.5 metres. We are committed to supporting onshore wind as part of a balanced mix of energy to meet the UK’s needs. Wind farms must be well designed and well sited to be approved, and the planning process can take account of concerns, including landscape and visual amenity concerns.

Edward Leigh: Will my good friend visit me in north Lincolnshire so that we can stand together on the edge of the Wolds, an area of outstanding natural beauty, near the Ramblers church at Walesby and look at the amazing Lincolnshire clay and the 40-mile view? Will he then come back in 10 years’ time to see that great view desecrated by vast arrays of windmills 100 metres high, all in the name of some controversial science? Can we not place these windmills somewhere where they do not desecrate our lives?

Edward Davey: The hon. Gentleman will know that I benefit from an infallible Minister of State who comes from Lincolnshire. He keeps me informed of all the issues to do with Lincolnshire and gives me his own particular line on them. I can reassure the hon. Gentleman that I am well versed in Lincolnshire issues. We take community concerns seriously, not just in Lincolnshire but across the country. That is why we published the call for evidence on community benefits in September. We will report to the House on that in the summer.

Fuel Poverty

Adrian Sanders: What steps he is taking to reduce the number of households in fuel poverty.

Rehman Chishti: What steps his Department is taking to tackle fuel poverty.

Gregory Barker: We have in place the green deal and the energy company obligation, which we expect to provide support for at least 230,000 low-income and vulnerable households each year. In addition, our warm home discount scheme supports 2 million households in total, and this winter has already helped more than 1 million of the poorest pensioners. We also make cold weather payments and winter fuel payments.

Adrian Sanders: The previous Government and this Government have a good record of working with energy companies to try to help vulnerable people. Could more be done, particularly for disabled pensioners who own their own home?

Gregory Barker: My hon. Friend is right and I am sure more could be done. That is why we designed the green deal and the ECO to be flexible and responsive to the needs of a range of energy consumers, particularly the fuel poor. If my hon. Friend has any particular ideas on that, I would be happy to discuss them with him.

Rehman Chishti: Will the Minister provide an update on the Government’s plans to publish a refreshed strategy for tackling fuel poverty this year?

Gregory Barker: My hon. Friend is absolutely right; the Government are committed to bringing new ambition and vision to tackling fuel poverty. The last fuel poverty strategy was published 10 years ago, and we will be coming forward this year with an ambitious strategy, pulling together all strands of policy and building on the latest evidence and creative thinking in that area. I would welcome my hon. Friend’s input, given his knowledge and experience in the area.

Alison Seabeck: I make my usual declaration of indirect interests. All MPs will be aware of the effect of fuel poverty on our constituents. A housing association in my constituency is trying desperately to upgrade its properties, which are in an appalling condition. It has fallen foul of the vested interest of a financial investment company which is the latest owner of the freehold for those properties. The
	company wants only to make a fast buck and is not prepared to renegotiate the contract, but in the meantime my constituents are suffering from bad health and an inability to pay their fuel bills. What can the Department do to help tackle those vested interests?

Gregory Barker: The hon. Lady is right and has a real point. The leasehold-freehold issue is one of the knottiest to tackle and has eluded successive Governments. I would be happy to sit down with her and look at that specific case to work out what more we can do to help the sorts of tenants to whom she refers.

Peter Lilley: Will the Minister confirm that, even by his own contentious estimates purporting that thanks to his measures the average effect of reduced energy use will offset the increase due to green levies, taxes and subsidies, two-thirds of households will be worse off? Since giving those figures, the Government’s estimates of savings from energy-saving measures have been reduced.

Gregory Barker: I am afraid I just do not agree with my right hon. Friend, despite his considerable experience and knowledge of the sector. None of us knows for sure whose forecasts are right, and we will not know until the time. A great deal of uncertainty is attached to all forecasts, but the latest Government forecasts to 2020 show that consumers will be better off due to our policies.

North Sea Oil

Michael Fabricant: What steps he is taking to ensure that oil from the North sea continues to make a contribution to UK energy needs; and if he will make a statement.

John Hayes: The North sea has been a major UK success story, and oil and gas will continue to play a key role in the energy mix for years to come. The Government continue to promote activity and investment in the North sea, and we maintain a close dialogue with the industry on how to support its continued development.

Michael Fabricant: My hon. Friend knows that the Government have issued more exploration licences than ever before, which is fantastic. However, there are many mature wells from which about 80% of the oil has been extracted. How can we set up a new procedure whereby we wring every single last drop of oil from those mature wells, and benefit the UK economy accordingly?

John Hayes: My hon. Friend is absolutely right: North sea oil and gas have a long and bright future. He may not have seen the report from Oil & Gas UK—as you may not have done, Mr Speaker—but it states that we are seeing the highest investment in UK offshore oil and gas development on record. The Government, too, are doing their bit. The brownfield allowances have encouraged that investment, and this is about growth, jobs and skills, as well as energy. I look forward to a bright future in the North sea for the United Kingdom and all those who work in that wonderful industry.

Anne Begg: Indeed, the oil industry does have a bright future; it is not a twilight industry. Miraculously, Scotland’s First Minister seems to have found a great deal more oil at the weekend, which will be very interesting to see. For the last drop to be wrung, as the hon. Member for Lichfield (Michael Fabricant) said, assets in the North sea will need to continue and many were not built to last as long as they have. What will the Government do to help companies to improve their asset integrity in the North sea?

John Hayes: The hon. Lady is, I am aware, the chair of the all-party group on British offshore oil and gas. I visited Aberdeen a week or so ago, and I am going again in a week or two. I have committed to visit Aberdeen more often even than my predecessor, who had a proud record in that regard. We need to bring in a new type of investor to the North sea industry. To that end, I have run investment events that will encourage the industry to link up with a new breed of investor. She is right: infrastructure matters and we must facilitate the investment to rebuild that infrastructure.

Charles Hendry: I am delighted to hear that my hon. Friend will be visiting Aberdeen as often as I did, because I found that to be one of the most inspiring parts of the energy portfolio. What more can we do to support groundbreaking, world-class companies here in the UK supply chain, so that they can take advantage of the opportunities here and overseas, and we can get the industrial benefit alongside the energy benefit?

John Hayes: My hon. Friend is absolutely right, and let me repeat that he was highly thought of in the industry, not least due to his commitment to the visits he made and to his work. It is key to recognise that many small and medium-sized companies are a part of this exciting opportunity. Often we see this issue in terms of very large oil companies, but it is the SMEs that require the extra investment I described in answer to the hon. Member for Aberdeen South (Dame Anne Begg).

New Generating Capacity (Investment)

Barry Sheerman: What steps he is taking to increase the confidence of the energy sector to invest in new generating capacity.

John Hayes: The UK is one of the most attractive places in the world to invest in energy infrastructure, and still more so since we published the Energy Bill. The certainty this provides is backed by complete cross-Government support unmatched by any other country in Europe.

Barry Sheerman: The Minister seems to be living in a parallel universe. I have a declared interest: I am on the environmental scrutiny board of Veolia, the environmental company. When I meet people who are being asked to make a long-term investment in the production of energy, they are very cautious of making any commitment at this time. What will he do about that? An energy gap, which is totally frightening for the people of this country, is emerging.

John Hayes: Just last week the Secretary of State, the Minister of State and I were in Downing street with the Prime Minister, making exactly the case to the investment community for which the hon. Gentleman is calling. I want him to join me in my universe. That universe is the universe of optimism, the universe of growth, the universe of success.

Caroline Flint: There was not much good news for bill payers in the answer to my last question, so let me try one about businesses. I am glad to hear about the summit in No. 10. Ministers say that investment in energy infrastructure is at a record high, but four out of five of the projects that they claim credit for either received planning permission or started construction under Labour. My hon. Friend the Member for Corby (Andy Sawford) earlier quoted independent sources saying that under this Government investment in clean energy has fallen by half. Businesses are saying that what they need now to invest is a target in law to decarbonise the power sector by 2030. Why will the Government not listen to them?

John Hayes: I have all sorts of prepared notes but I am not going to use them because the answer to this question is as plain as this: it is fine to have targets; targets matter because they signal direction. However, one must have weapons to hit those targets. What the Government have done that the previous Government did not—I do not want to be excessively critical—is put measures in the Energy Bill that will allow us to develop the weapons to hit targets. That is what investment is about: meeting targets, not setting them.

Energy Market Competition

John Baron: What steps he is taking to increase competition in the energy market.

Gregory Barker: Like my hon. Friend, we want more competition. One of the biggest barriers to entry and to greater competition is low liquidity in the wholesale power market. Ofgem is currently taking forward reforms to address that issue, and we are supportive of its progress, but the Government are also seeking backstop powers in the Energy Bill to allow us to act, should Ofgem and industry actions prove insufficient.

John Baron: I thank the Minister for that response. The billing stakeholder group produced a number of recommendations to increase competition, including putting more tailored information on the face of quarterly bills. Those recommendations were taken up by Ofgem and they chime with what the Prime Minister has said, but we know that the energy companies oppose them. Will the Minister give us an assurance that the energy companies will not be allowed to row back on those recommendations?

Gregory Barker: Yes, I can. I pay tribute to my hon. Friend for ensuring that these proposals, which will make a transformational difference to consumer bills, end up being enacted, and for the work of his stakeholder group. I can tell him that the proposals will be part of the licence conditions, and that if energy companies fail
	to deliver on them, they could be fined up to 10% of turnover. We are of course taking powers in the Energy Bill as well.

Marine Renewable Sector

Andrew George: What recent assessment he has made of progress in the marine renewable sector.

Gregory Barker: The most recent assessment of the marine energy sector was undertaken last year in the UK renewable energy road map. Our assessment showed that marine energy had real potential to contribute to our emission reduction targets beyond 2020. Up to the end of last year, 11 MW of wave and tidal technologies were deployed around the UK, but the coalition Government have big ambitions for the sector, which could expand to as much as 27 GW in the coming decades.

Andrew George: I am grateful to the Minister for that response. The £20 million investment that was announced two weeks ago is very welcome for marine renewables, but it will go into the tidal sector, which is already reasonably well developed. There are also major opportunities in wave power, however. Will the Minister meet me and industry representatives to try to move the wave hub forward and to bring it up to a commercial scale?

Gregory Barker: Most certainly; I know that my hon. Friend is a powerful champion of wave power. I am delighted with the progress of the marine energy park in the south-west. I was there last week for the RenewableUK conference to witness the signing of a memorandum between the south-west marine energy park and the Pentland Firth and Orkney waters marine energy park. I would be delighted to work with my hon. Friend to see what more we can do to drive the exciting progress in this sector.

Topical Questions

Andrew Jones: If he will make a statement on his departmental responsibilities.

Edward Davey: The core purpose of the Department of Energy and Climate Change is to power the country and protect the planet, and to avoid catastrophic climate change while providing secure, affordable energy supplies to the UK.
	I want to take this opportunity to express my regret at the closure of Daw Mill colliery following a fire. The closure will be felt keenly by the communities surrounding the colliery, and particularly by the families of those whose jobs are threatened as a result. We are in close contact with UK Coal and the unions to try to develop a way forward, as the Minister of State, my hon. Friend the Member for South Holland and The Deepings (Mr Hayes) said earlier. Since the last oral questions, the Energy Bill has continued its passage through this House and we remain on track.

Andrew Jones: There are proposals to create what will be the largest onshore wind farm in the country on the edge of my constituency. I am a huge supporter of renewable energy, but I have major reservations about onshore wind, as I believe it is very expensive and unreliable. I am therefore not at all supportive of the proposals. Does the Secretary of State agree that we have enough onshore wind farms already?

Edward Davey: I am sorry to disappoint my hon. Friend but I cannot agree with that bold statement, not least because onshore wind is one of the cheapest—if not the cheapest—of the large-scale renewable technologies. It has huge benefits. The planning system is important, however, and local communities can have a say on these matters. One reason that we published the call for evidence on community benefits was to ensure that local communities benefit more from hosting such installations.

Pamela Nash: The village of Salsburgh in my constituency is not on the gas distribution network, which means that the inhabitants have to spend more money on electric and oil heating systems. That situation is replicated throughout the country. What are the Government going to do to tackle the issue?

Edward Davey: The hon. Lady raises an important issue, and it is one that many hon. Members have experienced in their constituencies. In the past, people who are off the gas grid have not had the support they deserve, but the Minister of State, my hon. Friend the Member for South Holland and The Deepings is looking into the matter. We are looking at tackling fuel poverty through mechanisms such as collective switching, for example, and at renewable heat, which can really help people who are off grid. We are looking across the range of our policies to see whether we can help.

Neil Carmichael: In my Stroud constituency, we have a large number of innovative energy firms eager to pursue research and development projects. One area I think worth developing is energy storage, particularly storing electricity, which answers quite a few questions about engineering and providing an industrial base, as well as the peak problem in relation to renewable energy. What measures will the Government take to encourage investment in energy storage?

Edward Davey: My hon. Friend is absolutely right. I think energy storage technology holds out massive potential for the future, and UK firms are at the cutting edge of some of these technologies. When we finalised the Energy Bill, we said that we were minded to run a capacity market next year. One thing we would do with that is to have an early capacity market auction for demand-side response and storage technologies. That would send a very clear signal to these innovators.

Several hon. Members: rose—

Mr Speaker: Order. Let me remind colleagues of the premium on brevity at topical questions. I want to get through everybody’s question so Members need to help me to help them.

Steve Rotheram: I have written previously to his Department, so the Secretary of State should be aware that the people of Merseyside pay more for their electricity than people anywhere else in England. Will he therefore insist that Ofgem recommends a price reduction so that people in Liverpool pay the same tariff as others elsewhere in the country?

Edward Davey: I am sure Ofgem will have heard the hon. Gentleman’s question. He will also know that Ofgem has proposed major reforms of tariff, which we believe will help many people, particularly those stranded on the so-called dead tariffs who are paying far more than they need to. This will, I believe, support competition in the market. Let me point out that the hon. Gentleman’s Front-Bench team is in favour of abolishing Ofgem—a particularly interesting position.

Chris White: In my constituency, a number of groups are looking at ways to set up new renewable energy projects. However, I have met some who have faced barriers from organisations such as the Environmental Protection Agency and other Government bodies. Will the Minister outline what help is being given to local community groups to get their organisations off the ground and will he look at ways of ensuring that the regulatory regime is proportionate both in cost and time to the scale of the projects involved?

Gregory Barker: This coalition is absolutely committed to driving a transformation in the take-up of community energy, so we are really keen to help community groups such as the ones my hon. Friend mentions. That is why we established LEAF—the local energy assessment fund—with £10 million and the low carbon communities challenge with up to £20 million. I would be delighted to talk to my hon. Friend about how we can help his communities to access that cash.

Barry Gardiner: What could be more topical than a challenge to the recently announced infallibility of the Minister of State, the hon. Member for South Holland and The Deepings (Mr Hayes). Indeed, there has been such a challenge—from Mitsubishi, Vestas, Alstom, Areva, Doosan and Gamesa. The Minister maintains that there should be no decarbonisation target until 2016; they have said that postponing the 2030 target decision until 2016 creates entirely avoidable political risks and slow growth in the low-carbon sector, handicaps the UK supply chain, reduces UK research and development and produces fewer jobs.

Mr Speaker: Order. We are grateful; we have got the gist.

Edward Davey: I am grateful for the hon. Gentleman’s question. I have seen that letter. He will know that there is a case, which I have supported, for bringing this forward and setting a target in 2014, but we have reached an agreement across the coalition. I think it is a very sensible agreement, because we are the first Government ever to propose setting a decarbonisation
	target. I think we should be proud of that. Rather than talking it down, the Opposition should realise that we have moved further and faster than they did.

Glyn Davies: I want to thank the Minister of State, my hon. Friend the Member for South Holland and The Deepings (Mr Hayes) for hosting a constructive meeting with the Welsh Assembly Member Russell George and myself earlier this week about planning permission for onshore wind farms and associated infrastructure in mid-Wales. Will the Minister tell us how he intends to ensure that more weight be given to the view of planning authorities and local communities when they fiercely oppose wind farms in their areas?

John Hayes: The Secretary of State has said—and I can do no more than echo his words:
	“I am clear that local people and their councils should not feel bullied into accepting proposals they do not want.”
	It is critical to listen to local communities. The call for evidence that my right hon. Friend has mentioned is, in turn, critical to that. I am delighted that I was able to meet my hon. Friend and his colleagues. He will await our response to the call for evidence with interest, as will the whole House, and I am sure it will be very good news.

John Cryer: Further to question 2 on the deep-mining industry outlined by my hon. Friends, Britain could be facing a sharp rise in the importation of coal. On that basis, what assessment has the Minister made of the future security of energy supply in Britain?

John Hayes: Coal matters, for reasons of energy security, but jobs and skills matter too. People who do a dirty, difficult, dangerous job deserve our respect and support. The job that they do helps our energy security, and the Government understand that, which is why we will work to preserve that security and protect those people.

Andrew Selous: The United Kingdom is not alone in Europe in wanting to build new nuclear power stations. How can we co-operate with other European countries to our advantage, without ceding further powers to them?

Edward Davey: Only just last week we hosted, here in London, a meeting of EU member states which either have nuclear power or want to invest in it. We are working with them, not just looking for opportunities for new finance and so forth, but trying to ensure, together, that the EU understands the case for investment in low-carbon energy sources such as nuclear power.

Kerry McCarthy: In their response to the Environment Audit Committee’s report “Protecting the Arctic”, the Government said that oil drilling would be necessary in the Arctic to preserve domestic energy security and meet global demand. That was based on projections in the 2011 World Energy Outlook report. However, the 2012 report shows that projected demand can be met entirely by production from already discovered fields. Will the Government be reviewing their position in the light of that?

Edward Davey: As we said in our response to the Committee, we are working with members of the Arctic Council, which are the key countries that develop policies of that kind. We do not have the power to infringe their sovereignty, and I would not wish that, but we are working closely with them, particularly with close colleagues such as Norway.

Adrian Sanders: Many of my constituents are concerned about fracking, but I am not aware of any applications for fracking in the south Devon area. Can the Minister reassure my constituents that the Government are not aware of any such applications?

John Hayes: As the hon. Gentleman will know, we have established an office for unconventional gas and oil precisely in order to co-ordinate such matters. It is absolutely right for us to explore this opportunity, which could prove very fruitful, but we must do so in a safe and secure way, and a way that encourages communities to understand the benefits that it can bring them as well as the whole nation.

William Bain: The CBI estimates that more than a third of the pitiful economic growth that we saw last year came from the green economy. Why is the Secretary of State listening to the Chancellor rather than to green businesses, which say that they want a target in law for the decarbonisation of the energy sector by 2030 and they want that target now?

Edward Davey: The hon. Gentleman is right: green growth enables our economy to perform. We are seeing green growth, and I welcome that. I have been working closely with the Chancellor. The deal that we agreed before Christmas will mean a tripling of support for renewable energy, and, for the first time, the power to set a decarbonisation target will be put into law. That provides a framework that the last Government did not provide.

Julian Smith: I am concerned by the Secretary of State’s brush-off of my constituency neighbour, my hon. Friend the Member for Harrogate and Knaresborough (Andrew Jones), in connection with the Penny Pot Lane wind development. Communities throughout north Yorkshire are being bullied by wind companies, and money is being wasted. Will the Secretary of State meet me, and other north Yorkshire Members of Parliament, to discuss why the Liberal Democrat obsession with wind is not what north Yorkshire wants?

Edward Davey: I did not give my hon. Friend’s neighbour a brush-off. His hon. Friend—and my hon. Friend—asked me whether I thought that we had enough onshore wind. I do not think that, but, as my hon. Friend the Member for Skipton and Ripon (Julian Smith) knows, Secretaries of State rightly do not comment on local planning applications.

Andrew Gwynne: The last Labour Government helped to lift 1.75 million people out of fuel poverty. Does the Secretary of State expect next year’s fuel poverty figures, which will show
	for the first time what has happened under this Government, to reveal that fuel poverty has risen or fallen on his watch?

Edward Davey: I must remind the hon. Gentleman that the figures based on the old way of counting show that fuel poverty increased under the last Government. This Government have conducted an independent review of the way in which fuel poverty is measured, and it showed that the last Government could not even measure it correctly. According to the old measurement, the Queen was sometimes in fuel poverty. However, we are reforming not just the measurement of fuel poverty but the policies themselves, and I shall be producing a fuel poverty strategy later this year.

Marcus Jones: I want to thank the Minister of State, my hon. Friend the Member for South Holland and The Deepings (Mr Hayes) for the care and support he has shown for the workers at the Daw Mill colliery during this difficult time. In addition to the work he is doing, will he make representations to the Department for Business, Innovation and Skills to ensure that it is fully engaged with local organisations in the provision of careers advice, support and retraining opportunities for the workers who cannot be redeployed in the coal industry?

John Hayes: My hon. Friend has been a powerful champion of his constituents in this regard, as have my hon. Friends the Members for Sherwood (Mr Spencer) and for North Warwickshire (Dan Byles) of their constituents. I will, indeed, do what has been asked. In fact, I already have: there will be a bespoke tailored event run with local colleges, local authorities and Jobcentre Plus aimed at providing new job opportunities and reskilling for those who find themselves made redundant.

Alison Seabeck: The Hills fuel poverty review said that unless the Government changed course a further 200,000 families would be in
	fuel poverty within four years. Does the Secretary of State agree with the Hills conclusions, and if not, will he place in the Library the evidence on which he is basing his views?

Edward Davey: Professor John Hills’ report was extremely welcome and had a very important analysis. In reforming the design of the ECO, we took account of the understandings and research Professor Hills laid out, and that is also one of the reasons why we will be developing and publishing a fuel poverty strategy to show we are serious about tackling this issue.

Duncan Hames: In how many of the homes in need of improved insulation does the Minister expect measures to be taken over the remainder of this Parliament?

Gregory Barker: We do not have an exact figure, but we do think the green deal framework, supported by the ECO, is the best way of driving forward the very ambitious take-up of insulation measures that we will need not just in this Parliament, but throughout the decade.

Barry Sheerman: I am sure the Secretary of State knows about the Innovate UK conference held in Islington in London this week. Will he take a greater interest in clean, energy-efficient, sustainable production? There is a great market for Britain in this field; we lead the world, but we need leadership to make sure we conquer China, India and other markets.

Edward Davey: I was not aware of that particular conference, but I did attend an exhibition called Ecobuild, which showed many British companies that are innovating in saving energy. I am extremely aware of companies that are involved in clean energy, and I am working with my right hon. Friend the Secretary of State for Business, Innovation and Skills to develop supply-chain policies so not only are low-carbon technologies developed, but innovating British firms get the benefit and we have green jobs in this country.

Alcohol: Minimum Unit Price

Yvette Cooper: (Urgent Question): To ask the Secretary of State for the Home Department what is the Government’s policy on alcohol pricing?

Jeremy Browne: I am aware that there have been a significant number of media reports and stories in recent days about the Government’s proposal to introduce a minimum unit price, and I am grateful for the opportunity to clarify the Government’s position.
	The Government are determined to find the best way to diminish the misuse of alcohol. Over 44% of violent crime is alcohol-related. Fighting, antisocial behaviour and public drunkenness are familiar sights in many city centres, and there were 1.2 million alcohol-related hospital admissions in 2010-11. That is the context of our policy making and our inheritance from the previous Government. In March last year the Government published our alcohol strategy, which set out a range of measures to tackle the harms caused by excessive alcohol consumption.
	The Government have already introduced a wide set of reforms to tackle binge drinking and the corrosive effect it has on individuals and our communities. We have done the following: rebalanced the Licensing Act 2003 in favour of local communities by, for instance, removing the “vicinity test” to ensure that anyone, no matter where they live, can have input into a decision to grant or revoke a licence; introduced a late-night levy, making those businesses that sell alcohol late at night contribute to the cost of policing and wider local authority action; and introduced the early-morning alcohol restriction order, enabling local areas to restrict the sale of alcohol late at night in all or part of their area if there are problems.
	The Home Office has also recently consulted on a range of new proposals set out in its alcohol strategy—this is a wide-ranging consultation—and it includes a ban on multibuy promotions in shops and off-licences to reduce excessive alcohol consumption; a review of the mandatory licensing conditions to ensure they are sufficiently targeting problems such as irresponsible promotions in pubs and clubs; health as a new alcohol licensing objective for cumulative impacts, so that licensing authorities can consider alcohol-related health harms when managing the problems relating to the number of premises in their area; cutting red tape for responsible businesses to reduce the burden of regulation, while maintaining the integrity of the licensing system; and the introduction of a minimum unit price.
	The public consultation opened on 28 November— I imagine that all Members present contributed to it, given their interest in the subject—and closed on 6 February. We received a large number of responses covering a very wide range of views, including from members of the public, the police and licensing authorities, health organisations, alcohol producers and retailers, trade bodies and charities.
	On minimum unit pricing, there were—and are, in my view—powerful arguments on both sides of the debate. We have to ensure that we base our decision on a careful consideration of all the representations we
	received. We are evaluating the data precisely and we will announce our decision when this careful evaluation is completed.

Yvette Cooper: I asked what the Government’s policy was on alcohol pricing and I am still none the wiser. Yesterday, the Prime Minister said,
	“we must deal with the problem of 20p or 25p cans of lager…in supermarkets”—[Official Report, 13 March 2013; Vol. 560, c. 307.]
	But the Home Secretary has briefed that she has blocked minimum price plans. The Health Secretary said yesterday,
	“Like the Prime Minister I believe there is a case for minimum pricing”,
	but we have no idea what they are doing, and it seems that the Minister does not, either. And where is the Home Secretary? I have to say that I feel sorry for the Minister, who has been sent here to waffle to the world while the Home Secretary hides. She was skulking at Prime Minister’s questions yesterday, and her office will not tell me where she is today. There is something Macavity-like about this Home Secretary.
	What kind of mug is the Minister? War has clearly broken out between the Home Secretary and the Prime Minister, but while they hide in their trenches, the Liberal Democrats once again have been sent over the top. The Home Secretary was quick enough to come to this House when the policy was first announced. It was her policy; she supported it. When she set the price nine months later, she had no doubt. The Home Office document said that the Government are
	“committed to introducing a minimum unit price. However, in other areas”
	this consultation
	“seeks views on the introduction of policies.”
	So they were not consulting on the minimum price—they had made a decision.
	We know that the Home Secretary has overruled the Prime Minister; it appears she has also overruled herself. It was her plan; she has announced it twice. She said she was committed to it; now, she says the opposite. It is clear that this right hon. Lady is for turning—she’s just not for turning up.
	Alcohol abuse is very serious: to public health, and to law and order. We said that the Government were right to look at minimum pricing, but they needed to make sure that supermarkets did not just get a windfall and that the pub trade would not be harmed. They needed to look at the evidence and make sure the policies were workable. Instead, we have chaos and political confusion, and I ask the Minister again: what is the Government’s policy on alcohol pricing? The Prime Minister’s authority is in tatters; the Home Secretary’s credibility is in tatters; and the rest of us, including the Minister, do not have a clue what is going on.

Jeremy Browne: I read in the papers that the right hon. Lady fancies herself as the leader of her party. That was not a particularly impressive application. I am here as the Minister responsible for alcohol policy. She said she has no idea what the policy is, but I just spent five minutes explaining it. There was a lot of barracking from Labour MPs because they thought I was explaining it in excessive detail—that was how I understood it. I have explained the policy carefully. There is a consultation
	on the areas that I mentioned. The question people want answered is: what on earth is Labour’s policy on this?
	[
	Interruption
	.]

Mr Speaker: Order. The House really must calm down. It is in a very excitable condition, from which I hope it can be relieved by the hon. Member for Kettering, Mr Philip Hollobone.

Philip Hollobone: Was the balance of responses to the consultation in favour of or against minimum alcohol pricing?

Jeremy Browne: There is a range—

Nicholas Dakin: A range of answers.

Jeremy Browne: There is a range of answers. [Laughter.] There is a serious point here and it will emerge in this session, so let me address it. There are young people who drink cheap alcohol in excessive quantities and are price-sensitive when buying alcohol, so they are likely to be deterred from buying alcohol, to a degree, by minimum unit pricing. However, people on low incomes who consume alcohol responsibly would pay more under minimum unit pricing, and a number of representations have stated that the policy is unreasonable on that basis. We have to weigh up all those representations and points of view. The previous Government did not consider this matter at all. We are considering it carefully and will announce our conclusions when we are ready to do so.

Jack Straw: Is the Minister not aware that the very low price of the alcohol sold in supermarkets and convenience stores is the fundamental problem behind the abuse of alcohol and that not only is that, in turn, leading, as the university of Sheffield has estimated, to 10,000 unnecessary deaths over 10 years, but it is harming the decent pub trade and accelerating the closure of pubs? So this policy will benefit responsible drinking and also greatly reduce the health harm to a large number of young people. Why does the Minister not just get on and implement it? [Interruption.]

Jeremy Browne: As is being said around me, the right hon. Gentleman seems to have made a good case for why he should have taken action when he was Home Secretary. He chose not to do that, but he has explained one side of the argument on minimum unit pricing, and a number of representations replicated the point he just made.

Alan Beith: Will my hon. Friend bear it in mind that we could have minimum pricing in Scotland but not in England? Will he condemn the irresponsible policy of the Labour party on Northumberland county council, which is that if that happens Northumberland should be promoted as a cheap booze destination for Scots?

Jeremy Browne: rose—

Mr Speaker: Order. The Labour party’s policy in Northumberland is not a matter for the Minister of State—[Interruption.] Order. I do not require any assistance from the hon. Member for Broxtowe (Anna Soubry);
	she would not have the slightest idea where to start. The Minister may offer a brief view on this matter if he so wishes.

Jeremy Browne: Mercifully, the irresponsible attitudes of the Labour party are not my responsibility, but I can assure my right hon. Friend that the sort of irresponsible behaviour that people have become accustomed to from the Labour party will not be replicated by this Government.

Ben Bradshaw: It is a shame that the Minister cannot confirm the reports that Ministers have given to the press about this policy being abandoned. If those reports are true, will he, on my behalf, thank the Home Secretary for and congratulate her on actually looking at the evidence? There is no evidence that a minimum price would reduce problem drinking, far more effective interventions are available and this policy would devastate the west country cider industry. Will he assure me that this sudden outbreak of evidence-based policy will spread to other Ministers, including the Chancellor?

Jeremy Browne: The right hon. Gentleman, too, makes a strong argument, one diametrically opposed to that being made by the former Home Secretary, the right hon. Member for Blackburn (Mr Straw), who is sitting two places down from him,. That shows precisely why we are having a consultation; it might help the Labour party to come to conclusions, as well as the Government.

Tracey Crouch: The evidence from Canada and the university of Sheffield shows that the policy would have an impact, but minimum pricing should be just one aspect of tackling the problem of alcohol misuse in the UK. When Kent and Medway have almost 130 children under 17 receiving treatment for alcohol addiction, does my hon. Friend the Minister agree that minimum pricing is an essential way of getting some of our most vulnerable members of society away from access to high-strength, low-cost alcohol?

Jeremy Browne: I know that my hon. Friend takes a close interest in these issues. It is undoubtedly true to say, regardless of what conclusion one reaches on this issue, that some young people with low disposable incomes drink irresponsibly and are price-sensitive when buying alcohol. They are a particular problem. The question that we need to resolve is whether minimum unit pricing is the best way of tackling that problem, but that is precisely why we are having a consultation, and we will announce our conclusions when we are ready to do so.

Keith Vaz: Four years ago the Home Affairs Committee unanimously recommended minimum pricing for alcohol.

Ben Bradshaw: It was wrong.

Keith Vaz: My hon. Friend was not on the Committee so he was not part of that recommendation. Powerful arguments have been made by the hon. Member for Chatham and Aylesford (Tracey Crouch) and the hon. Member for Totnes (Dr Wollaston) on health grounds. The Minister will also know it costs an extra £59 per person for the police to process someone who is involved
	in alcohol-related crime. Given the powerful arguments in the consultation and in the Cabinet, on either side on this issue, when will we have a final decision?

Jeremy Browne: During my initial response, when Labour Members were sneering and jeering, I was explaining about early morning restriction orders and the late-night levy, which are precisely the types of measures that the Government have taken to address the problems the right hon. Gentleman raises. Of course there are health considerations as well, although one could make the case for an ever higher minimum unit on the basis that the higher the price, the greater the reduction in health harms. A balance needs to be struck, and we are seeking to strike it through the consultation. We will announce our conclusions when we have finished.

Sarah Wollaston: It is not only the entire medical establishment that backs minimum pricing on health grounds. I would like to read to the crime prevention Minister an e-mail I have received from a street pastor and to tell him what I am hearing from the special constables and police in my area. They say:
	“There is no doubt that the availability of cheap alcohol enables people to get into the habit of being very drunk, very often.”
	That has disastrous consequences on our streets. A third of people are unwilling to go out into their town centres.
	What is the crime prevention Minister’s personal view? It would be a shame if he became the crime promotion Minister.

Jeremy Browne: Again, I recognise the keen interest that my hon. Friend takes in these issues. I am aware that many people in the health sector share her view. The logic of their argument, as I have just said, is why stop at 45p? If we had a £1 minimum unit price, the health case would be made all the more strongly. The Government have to balance all kinds of competing concerns and other, also compelling, concerns about the affordability of alcohol for people on low incomes. They have to balance the role of the state and of the private individual and what choices the individual is free to make. Great tensions have become evident this morning in the Labour party, and the Government also have issues that they need to resolve.

Pete Wishart: The Minister will know that in Scotland we have our own plans for minimum unit pricing for alcohol to tackle our excessive consumption. It might surprise him to know that in Scotland the Labour party is opposed to the plans and will do all it can to thwart them. Will the Minister assure me that he will work closely with our Government to ensure that at least we can start to deal with our alcohol problems in Scotland?

Jeremy Browne: The Department of Health in London meets Health Ministers and officials in Edinburgh and we are keen to try to ensure that the harm caused by alcohol across the United Kingdom is addressed seriously. I am distressed to learn that the Labour party is so inconsistent on this matter. I thought being a credible Opposition involved having credible policy positions, but we have not reached that stage yet.

David Tredinnick: Does my hon. Friend agree that more needs to be done to keep pubs open so that people can drink under some supervision? If we are to do that, the price of drink in pubs must be considered. Will he discuss the beer duty escalator with the Chancellor?

Jeremy Browne: That is a consideration but there have been changes in how people consume alcohol. If the hon. Gentleman looks at the consumption of different types of alcohol, he will see that beer sales have gone down and wine sales have risen sharply. In many cases people are choosing to drink wine at home to a greater extent than would have been the case a generation ago. All those factors need to be borne in mind and that is precisely why we are ensuring that we get the details of the consultation right.

Alan Whitehead: The Home Secretary said a little while ago that the price of alcohol was causing fighting in town centres and that the minimum unit price was the answer. Has the fighting died down, or does the Minister think that it has merely been transferred to the Government Front Benches?

Jeremy Browne: The answer is that crime is at its lowest level since the independent crime survey of England and Wales began in 1981, 32 years ago. Crime is markedly lower—more than 10% lower—than it was when the Government came into office. The points the hon. Gentleman mentions about alcohol are all being considered as part of the consultation.

Martin Vickers: Does the Minister agree that minimum unit pricing would yet again mean that the responsible and law-abiding were paying for the irresponsible behaviour of others? Does he agree with the majority of my constituents who, although they recognise the complexities of the situation, would like to see a robust response from the police and courts?

Jeremy Browne: My hon. Friend makes a strong argument that replicates to a degree the one made by the right hon. Member for Exeter (Mr Bradshaw). Let us say, for the sake of argument, that an elderly person on a low income bought one cheap bottle of wine a week, on average, because they could not afford to buy a more expensive bottle. There is a strong argument against financially penalising that person by introducing a minimum unit price that would increase the cost of that bottle of wine when they are consuming the wine entirely responsibly and causing no wider social ills. Those are exactly the sort of issues that grown-up and responsible Governments must consider carefully.

Lilian Greenwood: The Prime Minister said yesterday that he would take action to stop the problem of 20p or 25p cans of lager being sold in supermarkets. How will he do that?

Jeremy Browne: I remind Opposition Members that nothing was done about these problems—[Interruption.] The idea that alcohol suddenly became cheap in May 2010 and lost of social ills came about as a result—[Interruption.]

Mr Speaker: Order. Throughout this urgent question there has been too much noise. Frankly, there is too much noise from those on the Opposition Benches, and I have to say to the junior Health Minister that she tends to behave as though every exchange is somehow a conversation with her—[Interruption.] Order. Do not shake your head. If the Government had wanted to put the hon. Lady up to answer, they could have done. They did not. In all courtesy, I say to her: sit there, be quiet and if you cannot do so, leave the Chamber. We can manage without you.

Jeremy Browne: Perhaps I should say in answer to the question from the hon. Member for Nottingham South (Lilian Greenwood) that we are having a thorough consultation, which has finished. We are considering the results and the way in which we will arrive at the best outcome will be announced in due course.

Bob Blackman: The central problem appears to be the anti-competitive behaviour of supermarkets that sell alcohol below the cost price. Does my hon. Friend agree that rather than introducing a minimum price, a ban should be introduced on measures that distort the market?

Jeremy Browne: My hon. Friend makes a strong point about anti-competitive practices. My personal view is that selling alcohol below cost price—leaving aside for a moment arguments about health harms and law and order considerations—is an uncompetitive practice, which is unfair on other retailers who cannot afford to subsidise their product. But a minimum unit price of 45p would lead to alcohol being sold considerably above cost price, so different considerations apply in that case.

Nicholas Dakin: I will give the Minister another chance at the question asked by my hon. Friend the Member for Nottingham South (Lilian Greenwood), pointing out that the Prime Minister said yesterday that he would take action to stop the problem of 20p or 25p cans of lager being available in supermarkets. Can the Minister give us clarity on how that is going to happen?

Jeremy Browne: I am giving clarity. I am explaining that there has been a widespread consultation process. There are a large number of factors that a mature, responsible Government would need to consider carefully. That is what this mature, responsible Government are doing, and when we are in a position to announce the conclusions, we will do so.

Henry Smith: Does the Minister agree that local initiatives to tackle alcohol misuse, such as the Crawley and Gatwick business watch scheme to label high strength alcohol and restrict its sale, have an important part to play?

Jeremy Browne: Yes, I agree that localism has an important part to play. We have sought to reflect that in the way we have changed licensing regulations—precisely the sort of practical, locally responsive measures that appear to be treated with contempt by the Opposition but are welcomed by communities across the country.

Kevin Brennan: Last year, in the foreword to the Government’s alcohol strategy, the Prime Minister stated:
	“So we are going to introduce a new minimum unit price. For the first time it will be illegal for shops to sell alcohol for less than this set price per unit.”
	When did that change?

Jeremy Browne: I fear the hon. Gentleman is confusing two separate issues—cost price and a minimum unit price. A minimum unit price of 45p, which is what the Government consulted on—in Scotland the proposed MUP is 50p, but we consulted on 45p—would price a typical 12.5% bottle of wine at about £4.20. Obviously, many bottles of wine currently retail at less than £4.20 but are not sold at a loss. That, I think, is the point of confusion for the hon. Gentleman. I have already said that selling alcohol below cost price is anti-competitive, but whether an artificial price floor should be put in by Government is precisely what we are considering in the consultation.

Peter Bone: May I thank the Minister for the way in which he has answered the urgent question? He has been exceptionally clear and he has been listening, like a great democrat. He is not in his Stalinist mode today. Does he agree that the last thing the people of Wellingborough want to see is alcohol prices artificially increased? Average families in my constituency are very concerned about a minimum price.

Jeremy Browne: I am grateful to my hon. Friend for his characteristic warm reception for Liberal Democrat Ministers. There are two strands to the case being made against minimum unit pricing, both of which clearly have some force. One is about charging people who may have low disposable income more than they would otherwise pay for alcohol, even when there is no evidence to suggest that all those people are drinking irresponsibly. The second is a wider liberal or perhaps libertarian argument about the role of the state and the right of the individual to make choices that he or she wishes to make, free from a more prescriptive view by Government. Both cases were made to us during the consultation and are part of our considerations.

Wayne David: Given that the Home Secretary has announced her personal support for minimum unit pricing on two separate occasions, will the Minister confirm that she has changed her mind?

Jeremy Browne: I am not in a position to announce the results of our consultation; if I were, I would be announcing the results of our consultation. There are genuine issues to be considered on both sides. I have tried to answer them as openly as it is possible for a Minister to do, but they are exactly the issues that we are weighing up.

Andrew George: As I am sure my hon. Friend agrees, judging by the questions coming from the Opposition, we are not sure what they are organising in a brewery on this issue. Given that the Health Committee looked at the evidence and came to the unanimous conclusion that it was in favour, does the Minister think that the House should have a free vote on the matter if we cannot come to a conclusion?

Jeremy Browne: These are not matters that I am responsible for, I regret to say. On the point about the Health Committee, I am aware of its view. I suppose the only
	point I would make is that we would expect the Select Committee that was responsible for health matters to have a particular perspective on the issue. If we had a libertarian Select Committee, it might say that people should be free to drink even in ways that damaged their health, which would also be a legitimate point of view. I am not saying that, just because the Health Committee’s perspective is predictable, it is not relevant; of course it is relevant, but it is one of a number of points of view, all of which we are considering as part of the consultation.

Russell Brown: As a member of the all-party group on alcohol misuse, I believe that minimum unit pricing is only one of a number of tools in the box. The Minister attended one of our meetings a number of months back. Can he explain why some of his views today have changed from what he said on that occasion?

Jeremy Browne: I do not accept that they have. I enjoyed the conversation that I had and I recognise that there are harms caused by alcohol. In fact, at the beginning of my answer to the question, about half an hour or so ago, I talked about violent crime and how much of it is alcohol related, about the atmosphere in town and city centres—everybody in the House will know from their constituencies how disconcerting many of our constituents find such behaviour—and about the number of hospital admissions that are alcohol related. I therefore recognise that there are serious concerns, but there are issues that need to be balanced. Otherwise, we would logically end up with the Government being urged to ban alcohol sales altogether—as far as I am aware, nobody is urging us to do that—or with a minimum unit price of, say, £5 rather than 45p. That would have a very big impact on alcohol consumption, but there are other, competing concerns that would not be addressed by going down that route. That is why a Government who govern responsibly for the whole country need to consider all these matters.

Several hon. Members: rose—

Mr Speaker: Order. These are extremely important matters and I am keen to accommodate remaining colleagues, but if we can have pithy questions and pithy answers, that would be helpful.

David Burrowes: It is not media reports or the balance of representations that matters, but the weight of evidence, which includes the impact on the 2.6 million children who live with a hazardous drinker and the 705,000 who live with a dependent drinker. For the sake of the hidden harm to those children, can we follow not the loudest voices, but the increasing evidence from Europe and, recently, Canada showing that affordability, consumption and reducing harm are inextricably linked?

Jeremy Browne: I pay tribute to my hon. Friend for his vigilant championing of the interests of children in households where such disadvantages blight their upbringing. I take seriously the point he makes. There are a range of concerns. There is a serious issue—Labour Members and others might wish to mull this over—about
	whether someone on a relatively high income who drinks a bottle of wine every evening should be treated differently from someone on a low income who drinks a much cheaper bottle of wine every evening. The second person could face a dramatic increase in the price of a bottle of wine under minimum unit pricing, whereas the first person, with the higher income, will almost certainly be buying a bottle of wine that is already above the minimum unit price. These issues must be considered as well, because it is reasonable for a Government to consider the impact on all parts of society.

Lyn Brown: I genuinely feel sorry for the Minister, because he has been thrown into the trenches and then over the top into Opposition fire to try to deal with the consequences of the Prime Minister over-speaking at Prime Minister’s questions, which seems to happen quite a lot, but I must press him on this. The Prime Minister said yesterday that he would stop the problem of 20p or 25p cans of lager, but what are the Government going to do?

Jeremy Browne: I would feel more sorry for myself if the Opposition could fire straight, but they seem to have formed a circle and been busy picking each other off, probably because the shadow Home Secretary showed a lamentable lack of policy clarity. [Interruption.] When she got to her feet, she seemed to have no idea what she thinks at all, so everyone on the Labour Benches—

Mr Speaker: Order. These exchanges are still very highly charged, but the Minister is entitled to be heard and must not be shouted down.

Justin Tomlinson: A member of my family is an alcoholic. Minimum unit pricing would not make one jot of difference, because 50p here or there would not break her addiction. Greater resources and co-ordination of support services is the priority; it is there that the industry and Government should be leading.

Jeremy Browne: I am very sorry to hear what my hon. Friend says. I think that it is important, amid all the party political knockabout, that we realise and respect the fact that this is a very serious issue for hundreds of thousands, if not millions, of people across the country, and they want politicians to address it properly and with consideration. With regard to price sensitivity, there is good reason to believe that different people in different circumstances are more price responsive than others, which is why this is a harder issue to tackle than it might appear after cursory inspection. I accept his point that people who have become accustomed to drinking large quantities of alcohol as a matter of course might be less price sensitive than, for example, younger people who are looking to drink alcohol to excess for the first time. Of course, we need to take a range of different measures into account when trying to help people in those circumstances.

Pamela Nash: I have to say that I do not agree with my hon. Friend the Member for West Ham (Lyn Brown), for a change, because I do not feel sorry for the Minister. I think that he would do well to remember that his Government have been in power for three years. Perhaps if he spent less time attacking
	the Labour party and more time formulating policy, he would not be in the mess he is in this morning. In response to my hon. Friend the Member for Cardiff West (Kevin Brennan), the Minister said—I think that he had better listen to this question—that the Government had not previously proposed a policy of banning the sale of alcohol below the cost of duty and VAT, but that was certainly my impression of their policy. Is he now saying that was never the Government’s policy and that it is not being considered in the consultation?

Jeremy Browne: After the grown-up, and in many ways sad, representation from my hon. Friend the Member for North Swindon (Justin Tomlinson), I am sorry that the hon. Lady did not rise to the occasion a little more. Since the Government came to office in May 2010, crime has fallen. In fact, it is now lower than it was in any of the 13 years Labour was in government. Alcohol consumption overall has also fallen since 2010, but that could mask the fact that some people might still be consuming alcohol to excess. Around 40% of the alcohol consumed in the country is consumed by 10% of the population, so there might be great hidden harms below those headline figures.

Nigel Mills: On behalf of the responsible drinkers of Amber Valley, I thank the Government for reconsidering this excessive nanny state policy. Has he considered what the policy might do to encourage further the already serious problem of the illegal sale of non-duty-paid alcohol?

Jeremy Browne: My hon. Friend makes a very strong point. The higher the Government set an artificial floor for legally acquired alcohol, the greater the profitability of distributing alcohol that does not comply with the Government’s own regulations. That is another of the points that make this issue a little more complicated, if one looks at it in a mature and reflective way, than it may appear if one looks at it from a cursory, party political perspective.

Alison Seabeck: This is a serious issue, and the public take it seriously. They also take very seriously what the Prime Minister stands up and says at the Dispatch Box, where on more than one occasion he has spoken about reducing the impact of low-price alcohol in supermarkets. One assumes, therefore, that he is given policy advice from the Department of Health or the Home Office prior to coming to the Dispatch Box for Prime Minister’s questions. Perhaps the Minister will be willing to make that policy evidence public for the rest of us to look at so that we understand why the Prime Minister is taking the line he is.

Jeremy Browne: We have published large amounts of evidence. As I said, we have had consultations on licensing regulations for local authorities, the late-night levy that has been introduced for local councils, and early-morning restriction orders. People are focusing on minimum unit price, but in our consultations we are also focusing on multi-buy promotions, licensing conditions, and the regulations—red tape, as I put it—that are affecting businesses. We are having this discussion in the House of Commons precisely because the Government have taken a leading role on this issue and have given it a profile that it was not previously given.

Fiona Bruce: My local authority, Cheshire East council, strongly supports MUP. It has calculated that in that one local authority area alone the cost to the public of alcohol harm is some £190 million across the NHS, local government, the criminal justice system, and loss to business. MUP is one of a number of tools, but if we extrapolate that figure across the country is it not clear that if it is not introduced the cost to the public will be far higher over time than a few extra pence on alcoholic drinks?

Jeremy Browne: My hon. Friend makes the case for a minimum unit price but, as I have said, it is not as straightforward as she implies. There are practical considerations. There are reasons to be concerned about people on moderate incomes who wish to buy alcohol at an affordable price and do not understand why the Government would wish to set an artificial floor that would make it more expensive for them to buy alcohol. There is a perfectly respectable libertarian argument that individuals should be free to decide how they live their lives without a prescriptive Government attending to the details for them.

Barry Gardiner: Contrary to the settled view of the House, the Minister has read the responses to the consultation. Will he remind the House which health organisations have responded and what they have said about the cost to the national health service of cheap alcohol?

Jeremy Browne: Large numbers of health organisations have responded. The Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry), who I am delighted to have here with me, has said that she will write to the hon. Gentleman specifically on who those organisations are, and I am sure that she will do that very speedily.

Glyn Davies: Does the Minister agree that the best way to deal with antisocial behaviour on the streets by drunks is strong action by the police and perhaps a few hours in the cells rather than piling extra tax on to responsible drinkers who are very often on low incomes?

Jeremy Browne: My hon. Friend makes an interesting point. In quite a lot of countries elsewhere in Europe, the price of alcohol is lower than it is here, or certainly low, and yet they do not have anything like the number of problems that we have in relation to antisocial behaviour linked to alcohol consumption. There is a role for the police, but there is a wider debate within society about how we consume alcohol and how we behave after we have consumed alcohol.

Ann McKechin: The Minister will be aware that the European Commission has formally objected to the Scottish Government’s proposals on minimum unit pricing. What discussions has he had with the Commission and what reassurances has he received from it that his proposals will comply with European Union law?

Jeremy Browne: The hon. Lady makes a reasonable point. The Scottish Executive wish to introduce a minimum unit price of 50p and we were consulting on a price of
	45p in this part of the United Kingdom. There is a legal challenge and we have to be mindful of the legal context if we choose to go down the path of introducing a minimum unit price.

Rehman Chishti: Will the results of the consultation be published so that people can see the strength of the arguments both for and against the proposal in different parts of the country? Did the shadow Home Secretary, the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper), or any other shadow Home Affairs Minister respond to the consultation, and if so what was their response?

Jeremy Browne: First, yes the results will be published. I have given some of the arguments an airing this morning and they will be provided in much greater detail. Secondly, I am afraid to say that despite the millions of pounds of Short money paid by taxpayers in my constituency and that of my hon. Friend to fund the activities of the Labour party, it seems to be lamentably short of the requisite standard of a proper Opposition.

Andrew McDonald: The Government ditched the proposed ban on the sale of alcohol below the cost of duty and VAT. Will they bring that back?

Jeremy Browne: We have had a consultation and we are reflecting on its results. We will make further announcements to those we have already made on alcohol strategy when we are in a position to do so.

Apprenticeships

Matthew Hancock: With permission, Mr Speaker, I would like to make a statement about the future of apprenticeships.
	Apprenticeships are back. Having existed in this country for more than six centuries, apprenticeships have through the ages provided the vehicle for skills and trades to be handed down the generations. At their best, they are an engine for social mobility and for giving employers and apprentices alike the skills they need to prosper. Although apprenticeships declined in the previous century, this century they have started to recover and grow, both in number—500,000 started last year, compared with the approximately 350,000 who started at university—and in stature, becoming a career choice in their own right.
	Although that growth in numbers should be welcomed on both sides of the House—it is also good to be able to welcome the shadow Skills Minister, the hon. Member for Blackpool South (Mr Marsden), to his place—I think we will all agree that we must increase the quality of apprenticeships and make them relevant to today’s economy. We will not delay progress on making such improvements. Steps have already been taken to require every apprenticeship to be a real job and to mandate that, in most cases, an apprenticeship lasts a minimum of a year, and today we are announcing that we will further strengthen the provision of English and maths in apprenticeships. The employer ownership of skills pilot is putting power in the hands of employers to design qualifications and deliver apprenticeships in line with employer needs, and we are extending apprenticeships to higher levels of skills and into new professions, such as insurance, accountancy and the law.
	We need, however, to go further. Last year we published a report by the former dragon from “Dragons’ Den”, Doug Richard, on the future of apprenticeships. I pay tribute to his work in producing that report, which called on us to put employers in the driving seat, giving them more control over qualification design, training delivery and funding. It called for quality and standards to be raised across the programme and for a focus on outcomes, stripping out bureaucratic processes. It also called for more open data, more awareness and more employer engagement in schools.
	We wholeheartedly agree with the principles and vision of the Richard report, which, along with the response that we are publishing today, will be placed in the Library, providing a programme of reform that will be challenging for all involved in apprenticeships—providers, the Government, employers and apprentices themselves—which is absolutely right. Rigour and responsiveness will be our guiding principles. The Richard reforms build on the best of this historic programme, but will once again attune it to the needs of the modern workplace.
	Specifically, we agree that apprenticeships should be targeted at those in new jobs or roles to train them for that role as a springboard for their future careers; that employers should be at the centre of designing apprenticeship standards and qualifications; and that assessment should be largely at the end, more independent and graded. We agree on the need to raise further the standards in English and maths, and that employers
	should be given greater control of funding to ensure that it is directed where it adds most value. Costs will be shared between apprentices, their employers and the Government. We agree that more open and accessible data are vital. We agree on the importance of improving awareness and engagement with schools, so much so that the Prime Minister has set out that it should become the new norm for young people to go to university or into an apprenticeship.
	This is a widespread package of reforms, on which we will consult widely and which we will implement sensitively. The consultation will stay open until 22 May. We will carefully consider the responses over the summer. People should be in no doubt that apprenticeships are a force for good. These reforms will help Britain in the global race by supporting unambiguously those who want to work hard and get on in life. They will help give all people the chance to fulfil their potential. I commend this statement to the House.

Gordon Marsden: I thank the Minister for his statement.
	In one respect at least, the Government have dealt comprehensively with the Richard review: they have comprehensively fudged or ignored most of his main recommendations. It reminds me of the old saying from the Clerk in the Table Office that one will always get a reply from Ministers, but not always an answer. I have been through the 10 specific recommendations that Doug Richard laid out in his report on apprenticeships. With the exception of the redefinition of the apprenticeship outcomes and the other matters that the Minister mentioned in that respect, all of which we agree with and welcome, I would give his answers two and a half out of 10 or possibly three. [Interruption.] Government Members should compare forensically the recommendations and what the Government have said.
	It would be interesting to hear what Mr Richard makes of the Government’s response to his report. Ministers and their advisers were clearly too nervous to obtain or include any comment from him in their press release. They also completely omitted any reference to Mr Richard’s central recommendation on incentives for employers to invest in apprenticeship training.
	There is a depressing pattern in the Government’s responses to new ideas for apprenticeships. They pat their advisers on the head, but ignore the main conclusions of the reviews that they have set up. They ignored Jason Holt’s advice last year on boosting apprenticeships with small and medium-sized enterprises, such as the need for impartial face-to-face careers guidance for young people. They voted here on Tuesday against the proposal of the Business, Innovation and Skills Committee to use public procurement to boost apprenticeship numbers. Now they have sidelined the key recommendation of Doug Richard’s report, again ignoring the need for a proper programme of advice and work experience in schools.
	I want to ask the Minister the following questions. One of the central points of Doug Richard’s report was the need to incentivise employers’ funding. Does the Minister see the recommendations on funding made by Doug Richard and Lord Heseltine as complementary? What view does Mr Richard take of that?
	The Government response says only that they are moving towards improving the attainment of level 2 functional maths and English. Why have they ignored Richard’s key recommendation that people should have level 2 functional maths and English before the completion of an apprenticeship? Will the Minister do anything to introduce work-based learning to support entry to employment and apprenticeships, as recommended by Mr Richard? Will he confirm that the Secretary of State for Education will provide dedicated funding for face-to-face guidance in schools to deliver improved awareness of apprenticeships among students and parents, as Mr Richard recommended? What measures will he take to support smaller businesses engaging with the apprenticeship system, and what is the timetable for that? How will the Government implement the new definition of apprenticeships as recommended by Mr Richard, and when will they do that? Finally, why have they ignored Doug Richard’s proposal to make some off-site learning mandatory?
	The Government have ignored the key point with which Mr Richard began his recommendations. He said:
	“It is important to stress that the different elements must be taken collectively: they are interlinked and the system will only make sense and be deliverable if all the elements are adopted as a whole”.
	The Skills Minister has failed completely in his second day job at the Department for Education to reanimate the dead hand of the Secretary of State, whose fingers are all over this report on the failures of apprenticeships, failure to deliver work experience, and failure to make changes to guidance. No wonder employers and business organisations are wringing their hands over the Minister’s failure to take up fresh proposals from Holt and Richard. It is just as well that the Labour party has set up a skills taskforce that will come forward with fresh ideas to deliver the step changes that employers need, and address the crucial issues raised by Holt and Richard, which the Government have shown they are ignoring.

Matthew Hancock: I do not know whether the shadow Minister turned up after I answered several of the questions that he has asked. Given that the Government commissioned and welcomed this report, and put in place a consultation on the implementation of the principles within, I do not know how they can be ducking that report. If a report is published, and the Government publish a response setting out how they will take forward its recommendations, that is very much taking on that report and its recommendations, not the contrary.
	On the specific questions, I do not know whether the hon. Gentleman was present when I said that employers will be given greater control of funding to ensure that it is directed where it most adds value, and that costs will be shared. That is the answer to his specific question on funding. We agree with the principles, we are working and consulting on the options, and we will come forward with a full implementation plan in the autumn.
	On information, advice and guidance, it is, of course, vital that schools give independent and impartial careers advice, and we are implementing that statutory duty. On small businesses, the whole point behind making the funding co-funded by and flowing through businesses, is to make it easier for businesses to access that funding. The brutal fact is that at the moment, more than half of apprenticeships are in small and medium-sized businesses.
	The biggest disappointment is that on a set of reforms that will improve and strengthen the quality of apprenticeships, there was not one positive word from the Opposition Front-Bench spokesman. I have no doubt that we will hear positive words from elsewhere in the Chamber about the value of apprenticeships and how they help everybody reach their potential, but there was not a single positive word from the Opposition.

Several hon. Members: rose—

Mr Speaker: Order. May I explain to the House that a very large number of right hon. and hon. Members will be seeking to catch my eye in the debate on NHS accountability, and I am keen to accommodate that Back Bench-inspired debate? We have business questions before that so I am not inclined to run this statement at length.

Philip Hollobone: Flexibility is key for any work-related apprenticeship policy. Does the Minister agree that apprenticeships should not just be for school leavers? They need to be for the mum going back to work after having looked after her children, and for the man in middle age seeking a new career. Will the Government address this issue?

Matthew Hancock: Yes, I agree strongly. For instance, soldiers leaving the armed forces often go through apprenticeships to retrain for civvy street. That is another important element.

Barry Sheerman: The Minister knows that I passionately believe in getting the apprenticeship question right, and we should use the Richard review to do that on an all-party basis. There is currently consultation and I hope that Opposition Front Benchers and Government Ministers will work together. At the moment, only 10% of employers take on an apprentice. If theirs costs are not met and if they do not receive an incentive, I do not think it will happen, but I support trying to achieve an all-party success.

Matthew Hancock: I agree. I enjoy working with the hon. Gentleman and I hope that those on the Opposition Front Bench come to their senses.

John Glen: Large employers, such as QinetiQ in my constituency, do very well, with large numbers of apprentices every year going into jobs after four years. My concerns relate to smaller employers. Will the Minister reassure the House that the needs and relatively limited capacity of small employers to engage with changes to apprenticeships can be accommodated in his plans?

Matthew Hancock: With a background in small business, I understand entirely. These plans will make it easier for small businesses to access apprenticeships.

Debbie Abrahams: In my constituency and across Oldham, 8.6% of young people are not in education, employment or training, and we have a lower than average number of 16-to-18 year olds in apprenticeships. As I understand
	it, the Minister is saying that there will be no response until autumn on the recommendations for engaging with employers. Can we therefore assume that, four years into this Parliament, the Government will have done little or nothing on apprenticeships?

Matthew Hancock: No, I said that actions are already being taken forward and I have announced some direct actions today. We are introducing traineeships in the autumn, which aim to ensure that young people have the skills they need to get a job and to hold down a job. That is part of our response too.

Dan Rogerson: People out in the world know that under this coalition Government the number of apprenticeships has risen dramatically. The Minister and his predecessor have done a huge amount of work. In considering recommendations to widen participation, will he look at accessibility in rural areas for those considering apprenticeships further afield or in an industry not based in their area, to ensure that everybody has the chance of an apprenticeship?

Matthew Hancock: Yes, I will.

Gisela Stuart: I served an apprenticeship, albeit in Germany. The success of apprenticeships in Germany is the result of the fact that they are not seen as an alternative for those who cannot go to university, but are seen as an alternative route to achieve the same aim. Will the Minister continue to stress that apprenticeships can be an alternative route, and that this is not just a question of either/or?

Matthew Hancock: I stress that as much as I possibly can, and the hon. Lady is well placed to make the case too.

Nigel Adams: In my constituency, more than 1,000 apprentices made a start in the past full year. Could we use this opportunity to thank the providers, colleges and employers that have made such a brilliant effort to give young people a great start in life?

Matthew Hancock: National apprenticeship week is all about celebrating exactly the sort of people my hon. Friend mentions.

Tom Greatrex: Following on from the question asked by my hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart), will the Minister reiterate the importance of ensuring proper awareness of apprenticeships in schools and beyond as an alternative? That is a recommendation of the Richard review, and it is vital if we are to see the take-up of apprenticeships and for them to be taken seriously.

Matthew Hancock: The new norm set out by the Prime Minister—that young people go into either an apprenticeship or university—is an important step. On the implementation of schools’ statutory duties, Ofsted has said that that will be a priority in how it assesses schools, and that is important. Some schools do brilliantly, but I want all of them to come up to scratch.

Robin Walker: Businesses in Worcester are already benefiting from the Government’s incentives to small and medium-sized enterprises to take on apprenticeships, and that is why we have seen the number of them more than double, with more than 1,000 taking them up. Can I urge the Minister to keep on pressing on both the quantity and the quality of apprenticeships?

Matthew Hancock: Yes, that point is very well made. The fact that more than half of apprenticeships are in SMEs is a good sign, but we need to ensure that as we increase quality, we also increase the numbers as much as possible. The fact that apprenticeships are becoming more rigorous will help to encourage employers to get involved.

Julie Elliott: With the demise of the professional careers service, how will the Minister ensure that the advice given to our young people in schools will be sufficient and that it will cover issues of diversity in making career choices?

Matthew Hancock: That is an important point. The statutory duty on schools is critical in ensuring that that happens, but there is more to it than that. From this summer, for the first time, the destination of people leaving school to go not only to university but into an apprenticeship has been published. With the statutory duty and the Ofsted inspection on the back of them, those destination data will help to push things in the right direction.

Julian Smith: The number of apprenticeships in Skipton and Ripon, and in Yorkshire more generally, has doubled. Will my hon. Friend confirm that under this Government, work will be the focus of apprenticeships, in contrast to the classroom-based programme apprenticeships that we saw under the previous Administration?

Matthew Hancock: Indeed; we have already shut down the programme apprenticeship route, as it offered an apprenticeship without a job. One of the central arguments in the Richard report, with which I entirely agree, is that apprenticeships are about getting the skills required to do a skilled job. Of course that is absolutely critical.

Steve Rotheram: I am also one of the few former apprentices in the House. Will the Minister confirm that the average length of stay on an apprenticeship programme has significantly decreased? Does he agree that short-term programmes and courses for adults are not proper apprenticeships, and that they simply dilute and discredit the apprenticeship brand?

Matthew Hancock: Yes. The quality of apprenticeships is vital, and that includes the length of an apprenticeship. We have introduced a minimum duration for apprenticeships, and we insist that, in all but exceptional cases, they should last for the minimum of a year. That is in the report, but it is an area in which we have already taken action.

Stephen Mosley: Apprenticeships have been one of the Government’s big success stories so far. In Chester, the number of apprenticeships has
	more than doubled, with 900 people starting one last year. When I talk to companies and businesses, however, I find that micro-businesses find it difficult to take on apprentices. Does the Minister have a view on how we can encourage companies with only one or two employees to take on an apprentice?

Matthew Hancock: We are making it as simple as possible. I studied at West Cheshire college in my hon. Friend’s constituency. Colleges and other providers can help small businesses to bust some of the bureaucracy, but I want to bust some of the bureaucracy myself to make it easier.

William Bain: Increasing skill levels will be among the critical long-term policies for turning around the slump in living standards, which is worsening under this Government. Will the Minister learn more from the German approach, in which larger companies receive stronger encouragement and have greater obligations to take on apprentices than is the case in the UK?

Matthew Hancock: I certainly agree that ensuring that everyone reaches their potential through apprenticeships and increased skills is vital. An apprenticeship involves learning and doing a job, and encouraging companies to come to the table is vital if we are to make this happen. Through the reforms and the principles set out in the Richard report, to which we have responded today, that is exactly the direction we want to take.

David Rutley: On Tuesday, I was fortunate enough to go to the annual Macclesfield apprenticeship fair, where I saw a wide range of organisations offering apprenticeships. They included McCann Manchester, Siemens and Cheshire East council, as well as the local hospital. What steps is my hon. Friend taking to increase the number of quality apprenticeships in the widest possible range of industry sectors?

Matthew Hancock: The whole report is about doing just that.

Diana Johnson: Small businesses in Hull tell me that the flat rate that they are paid to take on an apprentice does not take into account the particular needs of small businesses, and that it is the same rate as that paid to larger businesses. Will the Minister support the introduction of a differential rate for small businesses taking on apprentices?

Matthew Hancock: We have introduced a grant of £1,500 for small businesses taking on their first apprentices, precisely to help them with the bureaucracy that the hon. Lady mentioned, and I would encourage her to tell the small businesses that she talks to that it is available. The take-up has been good, but we need to ensure that everyone who could benefit from it knows about it.

Andrew Jones: Does my hon. Friend agree that employers will welcome the greater control of funding so that they can direct resources to where they need them most?

Matthew Hancock: I hope that they will. I welcome my hon. Friend as the apprenticeship ambassador in Parliament, as was announced today. His role is to ensure that we expand apprenticeships, listening to both parliamentarians and businesses as we take these reforms forward.

Ann McKechin: The Minister will be aware of the stark gender segregation in STEM apprenticeships. Will he tell us what steps he is going to take to achieve an increase?

Matthew Hancock: Yes, we have specific pilots to deal with this issue. The employer ownership pilot involves a consortium led by Rolls-Royce, BAE and others and it is aimed at increasing the number of women engaged in engineering. The best argument in favour comes from apprentices themselves. The apprentice of the year is a female engineer who works on the Typhoon Eurofighter. She is an inspiration, and it is the arguments that she puts—better than me—that will help to encourage girls and young women to look to engineering as an exciting career prospect.

Barry Gardiner: Can the Minister find it within himself to praise the General, Municipal and Boilermakers Union for its initiative with British Gas? Will he acknowledge that it is precisely the green skills apprenticeships that they are piloting together that will be the engine of growth?

Matthew Hancock: The engine of growth can come from all sectors in our economy. Apprenticeships have support across the piece. For instance, I find myself agreeing with Dave Prentis of Unison on the importance of employer ownership, so this is an area in respect of which many different parts of society and economy—including, no doubt, parts of the GMB—can work together to ensure that skill provision is made available.

Pamela Nash: Following the question put by my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), when I speak to small businesses, they tell me not just that they do not have enough money to take on apprentices—[Interruption.] I will continue when the Minister is listening. The small businesses that I speak to tell me that not only do they not have enough financial support to take on apprentices but that the money they receive covers only a small percentage of the actual costs. Will the Government’s proposals tackle this?

Matthew Hancock: Of course, the extra support we have given to small businesses is important, but the crucial point is this: apprenticeships are good for the whole economy; they are good for tackling skills shortages; they are good for apprentices, but they are good for employers, too. So it is right for all three—the Government, apprentices and employers—to pay their part towards the costs of apprenticeships because all three benefit from them. That is one reason why this is such a successful scheme.

Business of the House

Andrew Lansley: With permission, I should like to make a statement about the business for next week.
	Monday 18 March—I expect my right hon. Friend the Prime Minister to make a statement following the European Council. This will be followed by the conclusion of remaining stages of the Crime and Courts Bill [Lords]. Colleagues will wish to be aware that the business is expected to go beyond the moment of interruption.
	Tuesday 19 March—Proceedings on the Jobseekers (Back to Work Schemes) Bill, followed by motion relating to section 4A(2) of the Parliamentary Standards Act 2009.
	Wednesday 20 March—My right hon. Friend the Chancellor of the Exchequer will open his Budget statement.
	Thursday 21 March—Continuation of the Budget debate.
	Friday 22 March—Continuation of the Budget debate.
	The provisional business for the following week will include:
	Monday 25 March—Conclusion of the Budget debate.
	Tuesday 26 March—Debate on a motion relating to flood insurance, followed by pre-recess Adjournment debate, the format of which has been specified by the Backbench Business Committee.
	I should also like to inform the House that the business in Westminster Hall for 21 and 25 March will be:
	Thursday 21 March—Debate relating to the post-2015 development agenda.
	Monday 25 March—Debate relating to the e-petition on preventable cardiac deaths arising from sudden adult death syndrome.

Angela Eagle: I thank the Leader of the House for finally announcing the business for next week. I have been following this morning’s chaotic events largely on Twitter, and it is a deplorable state of affairs. It would be helpful to everyone in the House if the Government could get their act together and learn how to organise their business in a more timely fashion.
	Ninety-nine days have passed since the publication of the Leveson report, and a decision must be made. Now is the time to act for the many victims of press intrusion whom the report identified. We wanted a cross-party agreement, and we are disappointed that this morning the Prime Minister pulled the plug on the all-party talks. Even at this late stage, we urge him to think again. When he launched the inquiry, he looked victims in the eye and told them that he would fight for them. It is a sad indictment that he now fights for the people who hurt them.
	Will the Leader of the House guarantee that the Government will allow time for a debate and vote on any Leveson proposals in the Crime and Courts Bill on Monday? When can we expect to see the supplementary timetabling motion which was promised by Ministers yesterday, to facilitate the debate and the votes that must accompany it?
	I am beginning to think that my prediction that the Government will perform a U-turn every 29 days is going off the rails. The last one arrived three days early, and this week we have seen two more—and that is before next week’s Budget. Despite the urgent question, we still have no idea what the Government’s policy on a minimum alcohol price of 45p actually is. Will the Leader of the House tell us? Perhaps he will also let us know his personal view.
	The Government have amended the Enterprise and Regulatory Reform Bill in the other place to abolish the Agricultural Wages Board, which provides vital protection for rural communities. According to the Government’s own impact assessment, the abolition will take £260 million out of rural workers’ pockets and transfer it directly to their employers. The Bill is due to complete its Lords stages on 20 March. Will the Leader of the House tell me when it will return to the House of Commons?
	We were all startled by the vivid imagery from the Liberal Democrat conference last week. The party’s president said that his own members were
	“like cockroaches after a nuclear war”.
	The Deputy Prime Minister described his coalition partners as
	“like a kind of broken shopping trolley.”
	Mr. Speaker, I present you with our Government: a broken shopping trolley full of cockroaches, veering wildly to the right.
	Over the last week, the bookies have been raking it in because an important leadership election has been taking place. The front-runners have been jockeying for position, factions have been forming, there has been whispering in the corridors, people have been excited to see who will emerge as their next leader—and that was just in the Vatican. Meanwhile, here at Westminster, the Prime Minister is searching for divine inspiration. The Home Secretary has openly staked her claim, only to be silenced by the Education Secretary, who harbours his own ambitions. Perhaps the Prime Minister’s Aussie spin doctor should turn his attention to the Cabinet, and stop harassing Tory Back Benchers about their tweeting habits.
	The Budget is just under a week away. Everyone is wondering what the part-time Chancellor’s encore will be after last year’s omnishambles, and I have to say that the omens are not good. The Prime Minister has suffered an unprecedented ticking off from the Office for Budget Responsibility for obscuring the facts on cuts, the Business Secretary is openly campaigning for Labour’s plan B, and the Chancellor lost £1 billion in the 4G auction and has failed his own triple A test.
	The Chancellor’s plan is not working. People are suffering while our economy flatlines, and he is busy handing out tax cuts to millionaires. Perhaps he should listen to the 81% of his own constituents who think that he should spend less time in the Tory bunker and more time in his day job. The Guardian quotes a senior Tory as saying:
	“The Conservative party has two moods. Panic and complacency.”
	Will the Leader of the House tell us which mood he thinks his party is in?

Andrew Lansley: I am grateful to the shadow Leader of the House for her response.
	On press conduct and the implementation of the Leveson report, the hon. Lady will recall that yesterday the Minister of State, Home Department, my hon. Friend the Member for Taunton Deane (Mr Browne), made it clear in response to the debate on the programme motion that if the talks conclude, either with or without agreement, we will bring forward a supplementary programme motion to ensure that issues relating to press conduct are debated on the second day of consideration of the Crime and Courts Bill. That is what we are doing.
	The Prime Minister announced this morning that further all-party discussions have this morning concluded without agreement. For the benefit of the House I will read out what he has said:
	“I believe that what we have on the table is a system that will deliver public confidence and justice for the victims. It’s a system that would introduce the toughest press regulation this country has seen and a system that will defend press freedom in our country.”
	The Government will now publish the royal charter again so people can see how it would deliver the principles that Lord Justice Leveson set out. Through the consideration of the Crime and Courts Bill on Monday, the minimal legislative changes required to put in place a system of exemplary damages will be tabled. As the Prime Minister made clear this morning, other parties can also table amendments, although we hope, of course, that they will see that the minimal legislative changes supporting a royal charter will deliver what is required to balance a tough system of press regulation and the need for freedom of the press. The shadow Leader of the House asked me about the tabling of amendments and motions. As the House is not sitting tomorrow, they will have to be tabled today.
	I hope my comments have given Members an indication of the shape of the debate. My purpose is to facilitate the debate of the House. As the Prime Minister made clear this morning, the debate on Monday should resolve this issue and I hope the way the debate is structured—we can discuss that through the usual channels—will facilitate the House reaching a conclusion. The hon. Lady asked about other Bills, including the Enterprise and Regulatory Reform Bill. I hope these steps will enable us not only to achieve the implementation of the Leveson report recommendations, but to enable other important legislation to be concluded in a timely fashion.
	Now—[Interruption.] I think we can be quick on other things. On minimum alcohol pricing, the Minister of State at the Home Office, my hon. Friend the Member for Taunton Deane, has just responded to an urgent question, and my personal view is the same as his. [Interruption.] I agree with the Government, no problem.
	The Government’s decision to abolish the Agricultural Wages Board is an important deregulatory measure. The minimum wage will remain in place.
	The hon. Lady mentioned my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) referring to Liberal Democrats as cockroaches. We can squash that right now. We all know that Liberal Democrats have a capacity to fly away, as their symbols demonstrate, but we will leave it at that.
	The hon. Lady talked about next Wednesday’s Budget statement. I cannot pre-empt what the Chancellor will say, but there are a number of things the House recognises and the hon. Lady and her party ought to recognise: that we were left a dreadful financial mess; that we have
	cut the deficit by a quarter; that we have seen private sector employment rise by over 1 million; and, as was discussed when my hon. Friend the Under-Secretary of State for Skills delivered his statement to the House, 1 million people are going into apprenticeships as part of our creating sustainable growth for the future. We are making benefits fairer and we are making work pay. We have taken 2.2 million people out of income tax all together as a consequence of the increase in personal allowances. All this, and so much more, means the Chancellor will be delivering the Budget statement against a background of a record of achievement thus far and can set out proposals that will enable us to secure deficit reduction and our growth prospects for the future.

Harriett Baldwin: May we have a debate in Government time on the important steps this Government are taking to improve life for older people: not only reforms to the state pension but auto-enrolment and the pensions triple lock? All are such good news that we never get time to debate them on the Floor of the House.

Andrew Lansley: My hon. Friend makes a good point well. I confess that I cannot immediately identify when such a debate might be possible, but much can be discussed during the Budget debate. I noted, as many other Members will have done, remarks this morning from the House of Lords Committee underestimating what this Government have done to anticipate and create a more sustainable structure to support people in old age. We have made public sector pensions more affordable and sustainable, and auto-enrolment could give an additional 11 million people access to their own pensions in retirement. The draft Pensions Bill will make the state pension system simpler and more affordable, and I would never neglect to mention the many measures in the draft Care and Support Bill that will provide support for vulnerable and frail people in old age.

Ben Bradshaw: The Prime Minister has pulled the plug on the all-party Leveson talks today. He now expects this House to implement his version of press regulation, which would have no teeth and would not be independent. That would be a gross betrayal of the victims and a craven surrender to the perpetrators. Should we not have a full statement from the Prime Minister or the Culture Secretary, so that Members know exactly what they are voting for on Monday?

Andrew Lansley: Members will know the structure of the debate on Monday, and what is important is that, as was made clear yesterday and has been confirmed today, they will have the opportunity to have that debate. I took the trouble to repeat what the Prime Minister said at the Dispatch Box, so that Members are aware of what is now planned.

Simon Hughes: I thank the Leader of the House for his statement. It is extremely regrettable that the all-party talks on Leveson have broken down, and extremely regrettable that the Prime Minister is no longer willing to take part in them. I am clear on behalf of my colleagues here—and, I think, the official Opposition and other parties—that
	we do not think a simple charter, without seeking to implement Leveson as recommended, will be at all sufficient. Will the Leader of the House elaborate on Monday’s business? Given that it is likely that other amendments will be tabled—they are actively being constructed at this moment—can he make sure there is sufficient time to debate not just a Conservative amendment but other amendments? That means we will not have a short day at all, because some of us are determined to get it right and not dishonour our pledge made after the Leveson report.

Andrew Lansley: My right hon. Friend will have been listening carefully to what I said in my statement. I freely acknowledge that we do not always satisfy everybody in terms of the time made available, but I did say in my statement that colleagues must expect business on Monday to go beyond the moment of interruption, and I fear that will have to be the case. That will allow a debate, and without dwelling on precisely how we achieve that, my and my colleagues’ purpose, through the usual channels, will be to ensure that this House can have the debate—including the votes—that will enable it to resolve the issue, I hope very positively, so that all of us who are concerned to ensure that the Leveson report is implemented in principle see that happen. The Prime Minister set out some very clear proposals that will enable that to happen. I do not suggest for one moment that we will vote on those and not on other amendments, if others are presented. But the House should be given that opportunity.

David Wright: May we have a full ministerial statement on the bedroom tax, which affects thousands of people in Telford? A number of them will be single people looking for one-bedroom accommodation. When I checked, two such properties were available on the social housing register, and only 175 have been available all year. How are those thousands of people supposed to downsize? This is about them paying more money.

Andrew Lansley: The House and the hon. Gentleman will have heard my right hon. Friends the Prime Minister and the Secretary of State explain repeatedly that the spare room subsidy is about bringing fairness into the system. It comes in the context of a £23 billion housing benefit bill and circumstances where a large number of people in this country are living in overcrowded accommodation while many are receiving a subsidy in under-occupied property. Although the Labour party, over many years, was perfectly happy to see exactly the same principles applied to those in receipt of housing benefit in privately rented properties, Labour Members do not see that it is perfectly fair to carry that analogy forward into social housing.

Peter Bone: Leveson is a hugely important issue. Will the Leader of the House clarify whether the supplementary programme motion has yet been laid, so that we can table amendments? Will he allow Monday’s debate to go until any hour—I urge him to do so—as that would solve the problem of people worrying about having time to scrutinise it?

Andrew Lansley: I make just two points to my hon. Friend. As I hope I made clear, motions and amendments relating to proceedings on the Crime and Courts Bill on
	Monday need to be tabled today, and they will be laid in due course today. In effect, he is seeking to have no programme motion, with the time to be “on debate”, but I am afraid that I cannot offer that. It is important that the Bill is protected, although we will ensure that time is provided for the debate on press conduct matters.

Nigel Dodds: On 1 November 2012, the House debated air passenger duty, unanimously agreeing a motion calling for a “comprehensive” review of that punitive tax: the UK’s is the highest of any country in Europe and for many it is having devastating consequences for tourism, families going on holiday and so on. What progress has been made in response to the motion passed unanimously in this House?

Andrew Lansley: I can just tell the right hon. Gentleman that these matters are under active consideration by my right hon. Friend the Chancellor and others in relation to the Budget statement.

Philip Hollobone: In February 2011, the Department of Health announced that it would introduce a statutory register of herbalists by the end of 2012. It is now 2013 and the Department has not even published any draft legislation. May we have a statement from the appropriate Health Minister about the interference from the European Commission in preventing Her Majesty’s Government from introducing a new law of this land?

Andrew Lansley: I am grateful to my hon. Friend. As he will know, I am aware of this issue, having been the responsible Secretary of State when that written ministerial statement was made. I do know—this was true before I moved from the Department of Health last September—that we were encountering complex issues relating to the preparation of this legislation. The interface with EU legislation is one such issue, but it is not the only one. We need to get the legislation right, and I know that my colleagues in the Department are working on it and will, of course, make an announcement as soon as they can.

Dave Watts: Now that we can all see that the Prime Minister is in the pocket of Murdoch, may we have the Prime Minister make a statement explaining to the families, including the Dowlers, why he has gone back on the pledges he made?

Andrew Lansley: I do not accept for a minute what the hon. Gentleman says. I think that what the Prime Minister has described this morning as the proposals that will be brought forward for discussion in our proceedings on the Crime and Courts Bill next Monday is the toughest structure of press regulation this country has seen. I think it is entirely consistent with the Leveson principles, not least in the link with the Crime and Courts Bill and the introduction of a system of exemplary damages.

David Tredinnick: My right hon. Friend might recall my raising at Prime Minister’s questions in November 2010 the situation in Parliament square, which I described as
	“a no-go area surrounded by a campsite”.—[Official Report, 24 November 2010; Vol. 519, c. 257.]
	Our right hon. Friend the Prime Minister’s response was that he wanted it “sorted out” as quickly as possible. Will the Leader of the House update the House on the situation and give us some indication of the costs of policing the demonstration?

Andrew Lansley: I think that the House will, like me, be grateful to my hon. Friend for his assiduous work in raising this issue. Many Members of this House will take pleasure in celebrating the fact that Parliament square has now been returned to a state in which its splendour and the architectural setting surrounding it can be enjoyed by residents, workers and our many visitors to Westminster. He asked me about the cost to the taxpayer, but I regret to say that I do not know. However, I will draw his question, which he rightly raises, to the attention of the Mayor’s Office for Policing and Crime to see whether it might be able to respond to him about that cost, a matter for which it has been responsible.

Diana Johnson: May I reiterate the point raised by my hon. Friend the Member for Telford (David Wright) about the need for a clear statement on the bedroom tax policy? After all the U-turns, there still seems to be confusion about exactly how it is going to work. With 4,700 households affected in Hull and only 73 one and two-bedroom properties available, the Government need to be clear about how this policy is going to be implemented in practice.

Andrew Lansley: Of course the hon. Lady can reiterate the point, but I will not detain the House by repeating the answer. I will simply say that the clarification that she and other hon. Members actively sought was provided in the written ministerial statement made by colleagues earlier this week.

Andrew Jones: More than 20,000 people in my constituency—nearly a quarter of the population—are pensioners. Please may we have a debate about how our country will fund the pensions of the future, both state and private, looking particularly at what help can be provided to help people make provision for their own futures so that they have a secure and dignified retirement?

Andrew Lansley: That is an important point. The Budget may well afford an opportunity for some wide-ranging debates, of which pensions could be one part. The measures on auto-enrolment will support people in retirement. The draft Pensions Bill will give people a much simpler and more predictable basis on which to judge the state’s provision for retirement and what they may need to maintain the standard of living they are looking for. Overall, after years of failed experiments with stakeholder and other pensions, we are finally getting something that people can understand so that they can identify how they can meet their needs in old age.

Barry Sheerman: May we have an urgent debate on the one thing that blighted the Olympic effort, of which we are all very proud? That one thing was the behaviour of G4S. We now understand that it has done a deal with the London Organising
	Committee of the Olympic Games and Paralympic Games that is very generous, given its failure to deliver on its contract. At the same time, G4S is refusing to pay what is owed to the hard-working, smaller sub-contractors who worked on the Olympic site. This is a scandal; it will not go away, and G4S must know that Members of this House will not let the public forget it.

Andrew Lansley: The hon. Gentleman has put that point on the record. He will know that the Home Affairs Select Committee have been pursuing this issue. I cannot promise him an urgent debate on this matter, but if he were in the House and caught the Speaker’s eye, Home Office questions on Monday 25 March might present a suitable opportunity for him to reiterate his point.

Bob Blackman: Welfare benefits exist to provide a safety net for people who are not able to work, or the weak and vulnerable, and also a hand-up for people seeking return to work. May we have a statement or a debate in Government time on ensuring that welfare benefits are contribution-based so that those people who paid in through national insurance and taxation receive those benefits, and those who have not paid in are assessed on their personal need?

Andrew Lansley: Only a few weeks ago we were celebrating the anniversary of the Beveridge report, and it is important to recognise that the contributory principle was at the heart of that report. I cannot immediately offer my hon. Friend a debate. I am resting at the moment on the wide-ranging character of the Budget debates to allow many such issues to be raised. The House will recognise the importance of the benefit system being fair. It is important to distinguish between the contributory principle for many and the circumstances of those who are so vulnerable and dependent that we are talking about something that does not rely on contributions but is based on need.
	In the reforms that we are putting through now, we are focusing on making work pay and ensuring that those who can work do work, but also on making sure that resources are focused, and on increasing resources for those who are most in need through disability.

Kevin Brennan: So that we can understand the context of the debate on Leveson on Monday, can the Leader of the House tell us when the Prime Minister informed the Deputy Prime Minister that he was unilaterally collapsing the talks?

Andrew Lansley: I was not present at the discussions this morning between the leaders of the three parties, but I imagine that as the Prime Minister made a statement at the conclusion of those talks, it that must have been communicated in those talks.

Rehman Chishti: Medway council in my constituency proposes to invest half of its unallocated reserve in a new development fund to support future regeneration and development. Will the Leader of the House consider granting a debate on how local authorities can use their reserves to support local communities?

Andrew Lansley: I welcome what Medway council is proposing. I know that my hon. Friend will share my support for what my hon. Friends at the Department for Communities and Local Government are doing through their “50 ways to save” publication, which shows how councils can make significant savings. Many councils have reserves, quite prudently, and how they use those reserves, including for investment purposes or, in the case of my council, to work together with others to create an investment bank to support business projects in the county, can show initiative and enterprise.

Steve Rotheram: Following my point of order yesterday on the online petition for the Shrewsbury 24, will the Leader of the House make a statement on the Government’s online petition system? Specifically, will he ensure that the many thousands of people who have allegedly failed to fill out the online form properly are contacted electronically and notified that their signatures have not been registered?

Andrew Lansley: I am grateful to the hon. Gentleman for that question. I wrote to him yesterday following his point of order, although I entirely understand that he might not have received the letter yet. I will not detain the House with all that is in that letter, but I hope that it answers the questions he quite properly raised yesterday and today. If it does not, I would be glad to try to clarify further. This has demonstrated to me that there is no problem as such with the online petition system; there are just difficulties in some cases with duplications, addresses and things of that kind.

John Glen: My constituent Harald Hamley has recently contacted me to express his support for the Defamation Bill. I am sure that many across the country are anxious to see it become law to reduce the possibility of vexatious libel claims and to uphold freedom of expression. When does the Leader of the House expect the Defamation Bill to return to this House for further consideration?

Andrew Lansley: The answer to my hon. Friend is that I will make a statement on the further proceedings on the Defamation Bill in due course. It might help him and Mr Hamley if I say that as the Prime Minister has made perfectly clear this morning, we will resolve issues relating to the implementation of Leveson principles in our debate on Monday. As a consequence, I hope it will be possible for us to proceed with other legislation, including the Defamation Bill, in a timely way.

William Bain: Will the Leader of the House schedule a debate on the full scale of the collapse in living standards affecting our constituents which has been presided over by this Government? Has he seen the new research by Landman Economics for the TUC, published yesterday, which finds that the cumulative impact of Government policy on wages, tax and benefits is a drop in Scottish household income of £28.63 a week, or £1,488 a year? Is that not a truly dreadful record for this Government?

Andrew Lansley: Mr Speaker, you would imagine when listening to the hon. Gentleman that May 2010 was year zero and that nothing happened beforehand. At the heart of all this is the 6.2% reduction in the gross
	domestic product of this country as a consequence of the bust under a Government who said that there would be no boom and bust. It was the biggest bust we have ever seen and we were left with the biggest deficit we had ever seen. It is not possible to pay down debt, to cut the deficit and to cut consumer debt without having a negative impact on people’s living standards.

Henry Smith: Late on Monday night and in the early hours of Tuesday morning, hundreds of motorists were stranded by the freezing weather conditions on the A23 and M23 in west Sussex. I pay tribute to Sussex police and many of my constituents, who came to the assistance of those who were stranded. May we have a statement from the Transport Secretary about Highways Agency winter preparedness?

Andrew Lansley: I echo my hon. Friend’s praise for the emergency services and for his constituents—I was taken with the reports that the Red Cross, for example, was reaching out to people and giving them support. I know that they worked together around the clock in partnership with the Highways Agency and I, too, pay tribute to them. The extreme weather, which was probably experienced to a greater extent in much of northern Europe, had a heavy impact on the south of this country—

Pete Wishart: And Scotland.

Andrew Lansley: And, indeed, on other parts of the country. I note the request for a statement from my hon. Friend the Member for Crawley (Henry Smith). I do not anticipate a statement from my right hon. Friend the Secretary of State at the moment, but I can assure my hon. Friend that we constantly learn from what happens and apply those lessons in ensuring that we minimise disruption to the public and business during severe weather.

Tom Blenkinsop: David Green, director of Civitas, said today:
	“Labour is showing the way to the present Government, which has shown no imagination in tackling the problems facing SMEs and has ignored too many good ideas.”
	Given the failure of the Government’s Project Merlin and other such programmes, may we have a debate on the only growth plan—that is, Labour’s growth plan—including a British investment bank, regionalised banking and business lending?

Andrew Lansley: I know David Green, of course, and I suspect that he would not subscribe to the Labour party’s view of how these things should be tackled. None the less, we are determined to support small and medium-sized enterprises. We will push to ensure that small businesses can get access to the finance they need, as we did through Project Merlin, and we are supporting that through the funding for lending scheme and the finance guarantees. The tax measures that my right hon. Friend the Chancellor has put in place, including an exceptional tenfold increase in investment allowances, will support that. If the hon. Gentleman were at the conference being held by my old friends at the British Chambers of Commerce over the road today—I know that my right hon. Friend the Secretary of State for
	Business, Innovation and Skills will be there—he would hear their ideas. I know that many of them support what the Government are doing, including not only the deficit reduction but our infrastructure support and the business bank being set up by my right hon. Friend the Business Secretary.

Stephen Mosley: I know that my right hon. Friend has enjoyed many visits to the welcoming, historic and vibrant city of Chester. May we have a debate that will allow us to champion Chester as a stand-out candidate for city of culture in 2017?

Andrew Lansley: I am delighted to hear my hon. Friend be the first in this House to make a bid in business questions for city of culture status on behalf of his constituents. He is right to say that I have enjoyed visits to Chester many times and I look forward to more. Chester has a fantastic history and a vibrant artistic and cultural life, both now and in the future. I look forward to those visits, and perhaps we will share some of that entertainment when we are there.

Tom Greatrex: The Leader of the House might not be aware that next Tuesday marks the bicentenary of the birth of Dr David Livingstone, who was born in Blantyre in my constituency. Members will be aware of his work in Africa and he is, of course, buried in Westminster Abbey. There will be a series of events, including in Blantyre, culminating in a service in Westminster Abbey next week that we hope the President of Malawi, Joyce Banda, will attend. May we have a statement from the Secretary of State for International Development to update the House on the progress towards reintroducing foreign direct aid to Malawi to help in the progress that President Banda hopes to achieve in that country?

Andrew Lansley: I am glad the hon. Gentleman has had an opportunity to draw attention to that important anniversary and to the remarkable contribution of Dr David Livingstone as an explorer and someone who, as a consequence of that, was an inspiration to many in this country and beyond. I will talk to my right hon. Friend the Secretary of State for International Development. I am pretty sure she will be meeting the President of Malawi in the course of her visit, and I will draw my right hon. Friend’s attention to the points that the hon. Gentleman raised in the House so that she can incorporate them in that discussion.

Lindsay Hoyle: For the penultimate question, I call Mr Docherty.

Thomas Docherty: Thank you, Mr Deputy Speaker. Further to the points raised by the shadow Leader of the House, my hon. Friend the Member for Wallasey (Ms Eagle), and the right hon. Member for Bermondsey and Old Southwark (Simon Hughes), will the Leader of the House now confirm for the record that adequate time will be provided on Monday to debate not only the Prime Minister’s proposals but those of the Opposition?

Andrew Lansley: I hope that what I said was clear and helpful to the House. It is our intention to secure adequate time and to do so without prejudice to the
	discussion of other very important matters on the second day of the Crime and Courts Bill. That will necessitate the House sitting beyond the moment of interruption on Monday. I do not know precisely what other amendments there may be in relation to press conduct or the Crime and Courts Bill, but I know that we will work with the Chair and through the usual channels to ensure that the House is able to have a full and decisive debate.

Lindsay Hoyle: Last but certainly not least, I call Pete Wishart.

Pete Wishart: Thank you, Mr Deputy Speaker. Surely we will have a debate to mark the 10th anniversary of the invasion and the war in Iraq. Iraq remains our most damaging and appalling foreign policy adventure ever, with more than 100,000 dead and the region destabilised. I was in the House with the right hon. Gentleman when we listened to the nonsense and the lies from the Labour Government on the case for war. Surely we should revisit that next week.

Andrew Lansley: I was in the House, as the hon. Gentleman recalls, at the time of the debate leading up to the invasion of Iraq—[Interruption.]—and did not vote for it. The shadow Leader of the House is wrong in her intervention from a sedentary position. The hon. Member for Perth and North Perthshire (Pete Wishart) will be aware that a number of hon. Members have sought such a debate from the Backbench Business Committee. From the Government’s point of view, that is a matter for the Committee, but we are only too aware of the prospect of the Chilcot review coming forward at some point, and the importance of being able to debate and understand all the circumstances leading up to that decision in the light of the Chilcot review when it is published.

Points of Order

Peter Bone: On a point of order, Mr Deputy Speaker. The Leader of the House referred to the supplementary programme motion. I have checked with the Table Office and the Public Bill Office, and no such supplementary programme motion has yet been tabled. If Members seek to amend that supplementary programme motion, they have to do so before close of business today. Could you advise, sir, how we can amend a motion that has not been laid?

Lindsay Hoyle: It may be helpful for the Leader of the House to give us an answer to that question.

Andrew Lansley: It is just over four and a half hours until the close of business. We will strive to ensure that the supplementary programme motion is laid, with time thereafter for Members to seek to amend it, should they choose to do so.

Lindsay Hoyle: It may be helpful to the House to know that manuscript amendments are acceptable in an emergency, if need be.

Mary Creagh: At Department for Environment, Food and Rural Affairs questions last Thursday, I asked the Secretary of State why he, the Food Standards Agency and Sodexo had refused to name the company which supplied mince and burgers adulterated with horsemeat. The Secretary of State refused once again to name Sodexo’s meat supplier, thereby preventing other catering organisations from knowing whether their meat supplies were at risk, despite the fact that in every other horse adulteration case, the supplier has been immediately named. Yesterday evening Sodexo finally revealed its two suppliers as Brakes, which supplied the burgers, and Vestey Foods, which supplied frozen halal mince and frozen mince that were adulterated with horse. The chairman of Vestey Foods is hereditary peer Baron Sam Vestey, who is also Master of the Queen’s Horse. Have you had any indication, Mr Deputy Speaker, whether DEFRA Ministers intend to come to this place to explain to Members why they refused to name that meat supplier? Are they not putting their friends in high places above the interests of the consumer?

Lindsay Hoyle: I can certainly help and normally would take shorter notice that the hon. Lady was asking a question of the Chair. It is not a point for the Chair. As we both know, an urgent question was tabled. Normally I would not refer to that when a decision has already been taken. If nothing else, the hon. Lady’s question is on the record and I am sure that Ministers will have taken it on board, in the same way as we had a point of order yesterday which came up with the right answer in the end. If nothing else, the question will have been noted.

BILL PRESENTED
	 — 
	Jobseekers (Back to Work Schemes) Bill

Presentation and First Reading (Standing Order No. 57)
	Secretary Iain Duncan Smith, supported by the Prime Minister, the Deputy Prime Minister, Mr Chancellor of the Exchequer, Danny Alexander, Secretary Chris Grayling,
	Oliver Letwin and Mr Mark Hoban, presented a Bill to make provision about the effect of certain provisions relating to participation in a scheme designed to assist persons to obtain employment and about notices relating to participation in such a scheme.
	Bill read the First time; to be read a Second time tomorrow, and to be printed (Bill 149) with explanatory notes (Bill 149-EN).

Backbench Business

Justice Committee Report: Youth Justice

Alan Beith: I beg to move,
	That this House has considered the matter of the publication of the Seventh Report of the Justice Committee, on Youth Justice, HC 339.
	The Committee is having a busy week. We are publishing another report this week about the Government’s plan to abolish the Administrative Justice and Tribunals Council, but it is on the youth justice report that I shall concentrate today. As hon. Members know, I try to make a few points, then I take interventions. That is the only way in which hon. Members can take part in an exchange about the report, and we have 20 minutes in which to do it.
	We conducted a wide-ranging inquiry to explore the targeting of resources, the use and effectiveness of available disposals, and the role of the youth justice system in diverting at-risk young people from offending. We took evidence from many witnesses. We made visits to Belfast and to young offenders institutions in Feltham and Wigan and in Denmark and Norway. I am very grateful to Committee colleagues and to the Committee staff for all their work on the report.
	We found quite a lot to commend. The Youth Justice Board, youth offending teams and their partners have made great strides towards a more proportionate and effective response to youth offending that prioritises prevention. We welcome the fact that fewer young people are entering the criminal justice system. The numbers have been halved. We welcome the fact that, similarly, the numbers going into custody have been halved, although we are still high among the countries of Europe in the number of young people we have in custody.
	That is not to say that we believe that minor offending is being or should be ignored; rather, we believe it should be dealt with differently. When diversion is done well, young people are less likely to go on to more serious and prolonged offending. We are particularly encouraged that agencies in many areas are using a restorative justice approach to resolve very minor offending. Bradford youth offending team, for example, established restorative justice clinics as an arrest diversion, and only 10% of young people attending the clinics were re-arrested.

Nick de Bois: I am grateful to my right hon. Friend for his work in leading our Select Committee on this subject. Is he concerned, as I am, that we found the practice of restorative justice to be a postcode lottery around the country? Although we recommended that Ofsted may have a role to play when looking at care homes, we need a sense of urgency from the Government to advise on strategy in areas that are not delivering restorative justice. Does my right hon. Friend think we will have the impetus to achieve that?

Alan Beith: I agree with that comment. The phrase “postcode lottery” is one I do not like in areas where there is innovation because what happens is that
	some places show what good work can be done, and we want to spread best practice as quickly as possible, but I agree with my hon. Friend’s conclusion that the Government and we as a Committee should put as much weight as we can behind spreading the knowledge, experience and skills involved in restorative justice.
	On our visit to Denmark and Norway we saw the benefit of intensive multi-systemic therapy, with a concentrated range of skills dealing with young people who are on the fringes of the criminal justice system and likely to become involved in it.

Rehman Chishti: I congratulate my right hon. Friend on his leadership of the Committee. He talks about different strategies for dealing with youth. Does he agree that we should welcome the strategy proposed by the Government to deal with troubled families? There are about 200 such families in the country and, by giving them access to education, skills and accommodation, we will get them out of the criminal justice system and give them a long-term future away from that as good citizens.

Alan Beith: That is an extremely valuable initiative, and it relates to the point I will make later about early intervention, but as a Committee we think a lot more will need to be done in this area.

Steve Brine: I thank the Chairman, the Committee and the staff for the work they have done in producing what is a weighty tome. Further to that point, we say in the report, based on the evidence that the Royal College of Speech and Language Therapists gave us, that 10% of children in the general population have speech, communication and language difficulties, but the proportion of young offenders with such difficulties is 65% or just over. I am sure he remembers that we heard in evidence how this over-representation is part of a compounding risk model that begins at an early age. Does he therefore agree that, as well as ensuring that our youth justice system has access to speech and language therapists to help young people when they get into trouble and are in the system, we would be smart as a country to widen access—

Lindsay Hoyle: Order. Sir Alan was very generous and I allowed you to intervene, Mr Brine, but you cannot make a speech. You are meant to be making an intervention on Sir Alan, because he wants to reply and we need to get on to other business.

Alan Beith: I think I get my hon. Friend’s point. He is absolutely right, and he and the Committee have regularly reminded us of that problem. There are so many young people in the criminal justice system who might not be there if they had not been so lacking in communication and language skills. We have to put significant effort into dealing with that part of the problem.
	There will always be a need to detain a small number of young people who pose a risk of serious harm to the public, but youth custody is expensive. The Youth Justice Board spends £246 million on the secure estate, which is 65% of its total spending. Three quarters of those who leave youth custody reoffend, as opposed to a
	much smaller, but still too large, proportion of young offenders generally. That indicates that a lot of resource is going into a problem that we could better have prevented at an earlier stage.

Simon Hughes: I am grateful to my right hon. Friend for a very good report. Does he agree that two strong messages arising from his Committee’s conclusions are, first, that we still send too many young people into custody as opposed to dealing with them outside and, secondly, that we are still hopeless at providing for those who come out, particularly in accommodation, which would give them the security to prevent reoffending?

Alan Beith: Indeed, that is a point we make quite firmly: that the accommodation needs of people leaving custody are often not met adequately. If they are dumped in bed and breakfast without adequate support, that is no help to them.
	That applies particularly to looked-after children—that is, children who have been in care. Frankly, we were shocked by the evidence we received showing that vulnerable children are effectively being abandoned by children’s and social services. Public authorities have a duty to ensure that looked-after children are not at greater risk of being drawn into the criminal justice system than other children simply because they lack normal family homes. Poor behaviour that would be dealt with in the family should not be an express route into the criminal justice system. We heard one example of police being called to a children’s home to investigate broken crockery. The relevant authorities must also continue to provide support to looked-after children when they get into the criminal justice system and, even more, when they leave it. We were concerned that the relevant authorities often seem to end their relationship of providing support once looked-after children enter the criminal justice system, particularly if they go into custody, and we are talking about a group of very vulnerable children.

Andrew McDonald: I thank the right hon. Gentleman for his excellent chairmanship of the Committee. Does he agree that one of the key messages to come out of our work is about encouraging local authorities and prosecutors not to deal with trivial offences involving looked-after children in a way that causes them to enter the criminal justice system, but in the same way as ordinary families would? While I have his attention, may I also commend the report for its identification of the issue of brain injury among those in custody? The report sets out that although 10% of the population may sustain a brain injury, the incidence among those in custody is much higher, at 50% to 60%. Neuropsychological assessments of those in custody would be an excellent measure, and I congratulate him on flagging it up.

Alan Beith: What a telling statistic the hon. Gentleman has brought out—indeed, he brought it to the attention of the Committee, too. Although we are glad that a new system of assessment, ASSET-plus—assessing semantic skills through everyday themes—has been approved for use by the Government, we think it will take more than that to identify children who are vulnerable for that and a number of other health-related reasons. As for his point about treating looked-after children more as they
	would be treated in a family, if restorative justice skills are available and can be deployed and if training is provided, that can help to deal with difficult situations without putting looked-after children into the criminal justice system.

Elfyn Llwyd: I, too, commend the right hon. Gentleman for his chairmanship of the Committee. I am pleased with our recommendation that we should have legislation to ensure that the judiciary in criminal courts can refer under-18s to a single family court. That is important, bearing in mind his point about people entering the criminal justice system. Does he agree that we can learn a great deal in this context from the Scottish experience?

Alan Beith: The right hon. Gentleman makes an important point. The Scottish system of children’s reporters and children’s panels has been proven over many years. We still have some lessons to learn from it in England and Wales.
	Looking more widely at sentencing, we recommend a threshold to enshrine in legislation the principle that only the most serious and prolific young offenders should be placed in custody. We recommend that the custody budget should be devolved to a more local level, so that a local decision can be made about investing in effective alternatives to custody. We want to build confidence in community sentences by giving magistrates and judges more feedback on the outcomes of their sentencing decisions. We also want to take more action to reduce the number of people who breach the terms of their community sentences and address the problem that there is a large number of young black men in custody, far beyond their proportion in the population.

Peter Bone: What was the Committee’s view on the fact that if we send only prolific offenders to prison, they will clearly have done a lot of crime before they get there? What consideration was given to the short, sharp shock treatment as a way of dealing with people right at the beginning?

Alan Beith: The idea that we can sort out the problems of a young person who is committing serial, prolific crimes through a process that does not take much time is just a mistake. It takes time to address these problems. We have looked, for example, at the Willow unit at Hindley and a whole series of ways of trying to turn round the lives of young people. I am afraid that the short, sharp shock is an illusion. There is no proven way to deal with prolific young offenders other than by giving them a lot of attention over a significant period.

Jeremy Corbyn: I thank the right hon. Gentleman for chairing the Committee through the fascinating experience of undertaking this youth justice inquiry. Will he comment on the Rehabilitation of Offenders Act 1974 and say at what point a young person who has committed a fairly minor offence or a more major one would have it written off? We do not want a society in which misdemeanours undertaken by young people, for all kinds of reasons of poverty, naivety or whatever else, follow them for the rest of their lives, damaging their career prospects and us as a society.

Alan Beith: The hon. Gentleman makes an important point, which he has made in the Committee. The Committee recommended that, for example, minor offences that were the subject of cautions should disappear from the register at the age of 18, to give youngsters a chance to get a job and get started in life. I also commend employers who, in the knowledge that people have past criminal convictions, take them on and give them a fresh start, often with success.

Robert Flello: The Opposition very much welcome the right hon. Gentleman’s report. I hope we can have an early debate on it, because, certainly judging from the interventions we have heard, there is a need for one. How does he square his Committee’s view that we need to move away from young offender institutions to smaller, more specialised units with what seems to be the Secretary of State’s view—that we should go the other way and roll the smaller units into bigger YOIs?

Alan Beith: In fact, we have been closing young offender institutions over the years because the number in custody is now much smaller. The Committee will continue to press its view that most of the work that can be done successfully with young offenders has to be done in small environments, where it is possible to devote sufficient attention to their problems.
	There are a number of key things that I do not want to miss out. One is that the Government produced their own, “Transforming Youth Custody” document just as we were concluding our inquiry, so we did not have the chance to work on it in detail, although I have to say that there is not a lot of detail in it. One thing that puzzles us is the Secretary of State’s idea of creating youth colleges to deal with young offenders, because they are actually there, on average, for only 79 days. We fully support and applaud his interest in, and commitment to, sorting out the education of young offenders in custody, but the concept of the colleges does not fit well with the rapid churn of young offenders. In many cases it is important that we get them back into the education system. We have therefore recommended that schools and colleges could be incentivised to take young people back into education after they have completed their sentence, whether it is a custodial or community one.
	The Committee had something to say about deaths in custody. It is unacceptable that so many vulnerable young people continue to die in the custody of the state. We await the Minister’s view on whether to set up an independent inquiry and will return to the issue when we have heard what conclusion the Government have reached.
	We have many other detailed recommendations that I do not have time to cover today, but the message I want to leave with the House is that we must be prepared to make radical changes in the way we deal with young offenders if we are to stop them becoming the prolific criminal offenders of the future, which is often what they have the potential to become.

Philip Hollobone: I congratulate the Chair of the Committee on the report. Does he agree that one of the most powerful pieces of evidence in support of his emphasis on getting the transition
	from custody to the community right is that which was given by the chief inspector of prisons, who said that
	“the thing that unlocks everything else is accommodation. It does not mean that if you have settled accommodation everything else will turn out fine. It means that if you do not have that, nothing else will work”?

Alan Beith: Absolutely. Accommodation in that context often requires support as well; it is not merely bed and breakfast and goodbye. There has to be some way of ensuring that an offender reintegrates into society, or indeed integrates into society for the first time, because they might have had an institutionalised existence prior to that, which is true of many looked-after children.
	The second part of the message I want to leave with the House is that we need to ensure that new generations of children do not embark on crime. In order to achieve that, as was mentioned in an earlier intervention, we must develop early intervention. As with adult prisoners, so much of the Ministry of Justice budget is necessarily committed to custody and to prison by policies that have been pursued over many years, yet the most important work of preventing people from getting into crime in the first place is deprived of money.
	The Committee’s broad longer-term view is that we want to see resources not being needed to put people into custody or expensive sentencing processes because money has been spent dealing with troubled families and very young children beginning to show signs of later criminal behaviour—addressing that could prevent them from getting involved in crime in future. I am grateful to my Committee colleagues for the work they have done. We will continue to keep a close eye on Government policy in this area. We are glad to have had a good response to a number of our proposals, but a lot more needs to be done.
	Question put and agreed to.

Accountability and Transparency in the NHS

[Relevant documents: The oral evidence taken before the Health Committee on 12 February and 5 March 2013, on Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, HC 982-i and -ii.]

Charlotte Leslie: I beg to move,
	That this House believes that in the wake of the Francis Report it is clear that accountability and transparency are of paramount importance to patient safety and trust in the NHS; and further believes that across the NHS individuals found to have breached those principles should face the appropriate consequences.
	I would first like to thank the Backbench Business Committee for granting the debate; I realise that it did not have much time left to allocate in the Session and so am particularly grateful to its members for giving the House the opportunity to debate this timely and important issue. I would also like to thank all the Members who supported the motion, particularly my hon. Friends the Members for North East Cambridgeshire (Stephen Barclay), for Bracknell (Dr Lee), for Totnes (Dr Wollaston) and for Southport (John Pugh) and the hon. Member for Vauxhall (Kate Hoey). I must also thank all those who have contacted me, including the Patients First group. I am sorry if we are unable in the time available to do justice to all the information we have been given, but rest assured that this is the beginning of the scrutiny, not the end.
	This debate is neither about playing party politics, nor about only the future of one man, David Nicholson; it is about transparency, and about a deadly cover-up in our NHS and how we can ensure that never happens again. As one concerned former nurse wrote to me:
	“Please don’t let me read those meaningless words, Lessons Have Been Learned”.
	It sometimes seems that politicians can dodge taking responsibility so long as they say quickly enough that “lessons have been learned”, but learning lessons is not the same as simply uttering a phrase. The truth must be revealed, and consequences faced, if accountability and transparency are to be anything more than just words.
	Let me make it clear that refusing to play party politics is not the same as letting people evade responsibility and that statesmanship is not the same as letting people off the hook. We owe it to those outside this Chamber. We owe it first and foremost to those patients who were, in some instances, killed in our hospitals, and we owe it to their grieving families, for whom no amount of politicians saying that “lessons have been learned” can bring back their mum, dad, sister, brother, child or friend.
	After patients and their families, we also owe it to those dedicated doctors and nurses who were struggling to raise the alarm against a system that systematically suppressed their concerns. Many of them retired early in protest at what they were being asked to do, and some of them tried whistleblowing and were met not with thanks from the authorities, but intimidation and gagging. We will hear about some of that later.
	I must congratulate the Prime Minister and the Secretary of State for Health on their appointment of Don Berwick to ensure that the basic requirement of “Do no harm” is
	embedded in health care. Don Berwick, an adviser to President Obama, is an internationally renowned authority on health care. The Institute for Healthcare Improvement, which he co-founded and chaired for 21 years, is a world-leading centre of medical improvements based on proven success. I am delighted that the Prime Minister has put him right at the heart of improving our health care system.
	The tragedy, however, is that Don Berwick’s wisdom and recommendations are not new; they have been delivered before. They were delivered to the previous Government in no uncertain terms back in 2008, when David Nicholson was chief executive of the NHS. Instead of implementing them urgently, the previous Government were uncomfortable with what they revealed about their NHS, so they decided to suppress those truths. They suppressed a report by Don Berwick and his institute along with two other damning reports by international experts—RAND and Joint Commission International—that contained burning recommendations to be implemented with all urgency.

Alan Johnson: If the hon. Lady turns to page 1,281 of volume 2 of the Francis report, she will see that, far from the reports being suppressed, every one of them was seen by Robert Francis. He states:
	“As part of his work leading the working group, Sir Liam”—
	Sir Liam Donaldson, the former chief medical officer—
	“commissioned reports from three highly respected US-based organisations”.
	Francis concludes that section by stating:
	“Indeed it is clear that the NSR”—
	the next stage review, the Darzi review—
	“sought to address many of the concerns raised in these reports.”

Charlotte Leslie: rose—

Lindsay Hoyle: Order. Before the hon. Lady responds—[Interruption.] I am sorry, but does the Opposition Whip have something to say?

Lyn Brown: No.

Lindsay Hoyle: Thank goodness for that.
	We need short and concise interventions, because many Members wish to speak and I do not want to have to reduce the time limit further, but that is what will happen if we are not careful.

Charlotte Leslie: I congratulate the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) on seeking to defend his Government’s record. I will address his point fully later in my speech.
	Don Berwick’s report was commissioned by Ministers, led by Lord Darzi and with the support of David Nicholson, to celebrate the 60th anniversary of the NHS. It states:
	“The NHS has developed a widespread culture more of fear and compliance… It’s not uncommon for managers and clinicians to hit the target and miss the point”.
	It highlighted the inadequacy of quality control mechanisms in the NHS, stating that the priorities that are emphasised by these assessments are
	“seen as being motivated by political rather than health concerns”.
	It also highlighted the anger felt by many conscientious medics at Government changes to their employment and at being pressurised to put targets ahead of patients:
	“The GP and consultant contracts are de-professionalising... Far too many managers and policy leaders in the NHS are incompetent, unethical, or worse.”
	The report warns that
	“this… must be alleviated if improvement is to move forward more rapidly over the next five to ten years.”
	But those warnings were ignored, and we know that the improvements never happened. The report’s conclusion on a decade of health care reform is that
	“the sort of aim implied by Lord Darzi’s vision…is not likely to be realised by the 1998-2008 methods.”
	Don Berwick’s report was not alone; let me reveal what the other two reports said. They referred to
	“the pervasive culture of fear in the NHS and certain elements of the Department for Health”
	and stated:
	“The Department of Health’s current quality oversight mechanisms have certain significant flaws”.
	Perhaps the most damning indictment of all is that the politicians are responsible:
	“This culture appears to be embedded in and expanded upon by the new regulatory legislation now in the House of Commons.”
	But instead of being acted on with urgency, this was all buried. We know of the existence of Don Berwick’s report and the other reports only because a medic was so concerned that Berwick’s warnings and solutions had been buried that he tipped off a think-tank, Policy Exchange, which had to use a freedom of information request to bring them to public light in 2010, two years later. They were not even available to the Health Committee.
	Let us get one thing clear. The NHS is a huge, monolithic organisation with an exceptionally difficult and, some might say, almost impossible task. In reality, things will go wrong, sometimes very wrong. The crime is not so much that things were going wrong, bad as that is, but that instead of immediately focusing on tackling it, the priority was to cover up an awful truth that was uncomfortable for Ministers and chief executives. All too often, Dispatch Box appearance mattered more than the reality of patients’ lives, leaving whistleblowers and patient groups such as Julie Bailey’s, which was disgracefully dismissed by David Nicholson as a “lobby group”, screaming into a vacuum, often at great personal cost. The crime is the smothering of the truth which costs lives—the deadly silence.
	What was the cost of suppressing Don Berwick’s urgent prescription for the NHS? The clinical director of NHS Scotland recently suggested that in following Don Berwick’s recommendations it has experienced an estimated 8,500 fewer deaths since January 2008. We may well ask what was the cost in lives for our NHS of the previous Government’s decision to bury the truth. Across the 14 trusts now being investigated as well as Mid Staffs, there were 2,800 excess deaths between the time that the reports by Don Berwick and others were presented to Ministers and their final revelation in 2010. If the previous Government had been urgently implementing Don Berwick’s recommendations for those five years, who knows how many of those lives might have been saved?
	How was this allowed to happen? I have put in freedom of information requests asking what meetings took place to discuss the reports and who was present.
	Although David Nicholson was working closely with Lord Darzi on the next stage review, he said in front of the Health Committee that, incredibly, he
	“knew nothing about the reports”.
	That is the Select Committee, so we must take him at his word. The question that then remains is who did read and suppress these vital reports. Was it Ministers? Was it officials? If officials, how was this allowed to happen? If the Department of Health is to move away from a culture of cover-up, I expect a full and accurate response to my request to know who was responsible, and I ask the Secretary of State to assist me in that.
	Former Labour Ministers will complacently say, as they already have, that these reports fed into Lord Darzi’s next stage review and informed the report, “High Quality Care For All”. I ask the House whether a document that starts with the then Secretary of State, the right hon. Member for Kingston upon Hull West and Hessle, beamingly saying
	“On its 60th anniversary the NHS is in good health”
	reflects the content of the reports that we have just heard about. It certainly does not. Indeed, while the Department of Health claims that it “drew heavily” on the three reports in putting together “High Quality Care For All”, a source close to the authorship of those reports said that they found that claim to be “disingenuous at best”. David Flory, the deputy chief executive of the NHS, later told the Francis inquiry that he at least had some responsibility for what happened to the reports, as he had read them, but insisted that they were “caricatures”. That would help to explain why they were not acted on, but it makes the Department of Health’s insistence that it “drew heavily on them” rather odd.
	Further indication that the documents were not acted on is the fact that they raise issues almost identical to those highlighted five years later in the Francis report. If Don Berwick’s warnings had been acted on five years ago, there would be no need to ask him to come back now to step in to sort things out and implement his recommendations.

Alan Johnson: I wonder if the hon. Lady is coming to the point that Francis, a QC, in the course of a two-year public inquiry that produced two volumes, looked at all these documents and said that many of the issues within them had obviously been acted on. During a two-year review, Francis drew completely the opposite conclusions to those that the hon. Lady is drawing.

Charlotte Leslie: I find various elements of the Francis report rather strange, not least that the current chief executive, David Nicholson, is minuted as dismissing the activities of Julie Bailey as merely “lobbying” as opposed to expressing widespread concern about patients, and that this minute was dismissed in evidence, with David Nicholson saying that he could not recall ever having said something like that and thought that he could not possibly have done so. The fact that we are asking Don Berwick back five years after he initially gave his recommendations to Labour Members speaks far louder than a few sentences in the Francis inquiry with which people may beg to differ. However, I will not be distracted by the right hon. Gentleman but go back to my speech.
	I will now reveal how crucial mortality data, which Harvard university says should have triggered an “aggressive investigation”, was ignored, and, when it became too prevalent to ignore, was, like so many whistleblowers, discredited. David Nicholson said in response to the Health Committee that he did not know that the Dr Foster mortality data existed until he became chief executive of the NHS in 2006. He also said he did not know there was a problem with the mortality rate at Mid Staffs until 2009. Again, that is the Select Committee, so we must take him at his word. It is odd, however, as we know that David Nicholson attended a presentation in Birmingham in 2004 at which the Dr Foster ethics team gave a presentation on the real-time monitoring tools that it was using to show mortality alerts and the hospital standardised mortality rates.
	There are also records of Dr Foster telephoning chief executives of health authorities in 2005 to tell them about the mortality alerts. David Nicholson is named on that list of those getting calls, as chief executive of Birmingham and The Black Country strategic health authority. Between 2005 and 2009, there were 8,000 log- ons to the Dr Foster site from members of staff at West Midlands SHA. We even have a press release from Dr Foster from as early as 2005 congratulating Walsall hospital in, yes, West Midlands SHA, for its improvement in relation to this very same mortality data. The Dr Foster data was published in the “Good Hospital Guide” from 2000 onwards and in national newspapers from 2001 onwards. It is therefore incredible that it was not known about by someone such as David Nicholson, or indeed Ministers and others.
	By May 2007, however, people were aware of the data. The then chief executive of West Midlands SHA, Cynthia Bower—Birmingham and West Midlands SHAs play a strangely prominent role in this story—received alerts that there were issues with high mortality rates in the health authority. But instead of taking urgent action to find out what was going wrong, she commissioned the university of, yes, Birmingham to write a report to discredit the data, at a cost of £120,000 to the taxpayer. Stunningly, the British Medical Journal—the journal of the union, the British Medical Association—is on record as allowing the author of the Birmingham report to publish his findings in the BMJ four months before official publication to coincide with the publication of the Healthcare Commission report, in order to discredit the data. A fact little publicised by Ministers and chief executives is that the Birmingham report was severely flawed. Harvard later did a study and found that the data were so watertight that on receiving the alerts,
	“it would have been completely irresponsible not to aggressively investigate further.”
	Yet again, the reaction to bad news was to bury it, or expensively discredit it, rather than act.
	This went all the way to Government. I have seen an internal briefing for the right hon. Member for Exeter (Mr Bradshaw), then a Health Minister, in which officials brief him to stress that the mortality data were not known about until 2007. However, in that very same briefing it is revealed that they know this to be untrue, because they make specific reference to the data being published as far back as 2001 in the “Good Hospital Guide”.
	This is only a drop in the ocean of a catalogue of attempts to cover up the awful truth. It is utterly wrong that no one should be held to account for such negligence
	in their duty to protect patients. The “Code of Conduct for NHS Managers” says that managers must
	“make the care and safety of patients my first concern and act to protect them from risk”
	and
	“accept responsibility for my own work and the proper performance of the people I manage”.
	If talk of accountability in this Chamber is to have any credibility at all, especially for those individuals who buried loved ones while Government, departmental and NHS individuals buried the truth, actions must have consequences. To scapegoat is not the same as ensuring that those responsible are held to fair account. Those who do not have a voice—the patients and their families—deserve accountability and more than just words.
	Don Berwick is right. We must convert our anger over what has happened into action. That is what Julie Bailey did, without whom this debate and a push for a culture change in the NHS would probably not be happening. It is what my right hon. Friend the Secretary of State did this morning in banning gagging orders. Will he confirm whether that measure will be retrospective? I believe that this Government have secured a good base from which to put clinicians—not managers and politicians —at the heart of setting the priorities of our NHS.

Rosie Cooper: Although I appreciate and endorse everything the hon. Lady has said about accountability and the managerial code of conduct, who does she think should enforce the code and ensure that it is being followed? Beyond the board and the chief executive, how will organisations be policed?

Charlotte Leslie: I believe that Francis is right: a regulatory organisation for managers is needed.
	We must be brave. There must be a cultural clean-out and a new start, including a new head of the NHS Commissioning Board, who does not appoint a deputy who faces possible investigation for gagging whistleblowers —unless, of course, Dame Barbara Hakin deregisters from the General Medical Council beforehand—and who does not seem systematically to appoint those who had contact with West Midlands health authority or Birmingham, but has the trust and faith of doctors, nurses and patients, and epitomises this new era of transparency and accountability.
	I believe that with Don Berwick’s help—albeit about five years later than it could have happened—we are now beginning to step in the right direction to ensure that never again can the NHS be too loved to be scrutinised or too holy to be questioned, and that this debate will go some way to breaking what has been, for more than a decade, a literally deadly silence.

Andy Burnham: What happened at Stafford hospital was a betrayal of everything the NHS should stand for. We will face up to what went wrong and I will say more about that today. I repeat the apology to the families of people who suffered appalling abuse and neglect.
	We must do more. People affected will be watching this debate and rightly wondering what it will achieve. They want to know what is going to change and when.
	The time has come for cross-party agreement on a way forward, and that is my hope for this debate. There must be more accountability and transparency, and that is why we support the motion.
	We also support the Secretary of State’s ban on gagging clauses. It builds on statements made by the previous Government, which in turn were a response to previous scandals. That provides a crucial context for today’s debate.
	In 1997 Labour inherited the job of responding to the Bristol heart scandal and the Harold Shipman murders. A series of major policy developments followed on patient safety, inspection and regulation. We passed the Public Interest Disclosure Act 1998, protecting whistleblowers. We published data that had never before seen the light of day on survival rates from heart and stroke care, and 1999 saw the first ever independent regulation of hospitals and care standards.
	In 2001 we established the National Patient Safety Agency, which has sadly since been abolished and, in 2006, on the back of the public inquiry by Dame Janet Smith, the General Medical Council and the Nursing and Midwifery Council were reformed to end the professional closed shop. The truth is, however, that well-meaning as those steps were, there were places where the underlying culture of the NHS did not change and that is an important lesson for us all. When we make statements in this place and pass policies, we assume that everything changes on the ground, but it does not.
	The previous Government made similar statements to that made by the Secretary of State today, yet the use of agreements persisted. Why was that? The answer is that there is a culture in the NHS—a tendency to pull down the shutters and push people and complaints away when things go wrong—that is more ingrained than we might think.

Stephen Barclay: On the subject of pulling down the shutters, will the right hon. Gentleman confirm that the world-leading expert, Professor Sir Brian Jarman, wrote to him in March 2010 listing concerns about 25 hospitals with high mortality rates, and that both the right hon. Gentleman and the Care Quality Commission took no action?

Andy Burnham: No, I will not. I was copied into an e-mail by Professor Brian Jarman in mid-March 2010 and, having asked the CQC to investigate what he had said, I wrote back to him on 31 March 2010. That was literally my last duty as Secretary of State for Health after the general election was called. I was not able to respond further to inquiries. It is important to provide some balance to the hon. Gentleman’s comments.
	Changing the culture in the NHS requires vigilance and persistence. As Robert Francis says, we have all been too remote from the front line.
	The foundation trust reform was a serious attempt to end the top-down culture in the NHS, bringing more accountability and transparency. If we look back, however, we will see that, when the centre stood back, there were places where an unhealthy local culture became even more firmly established. In some trusts a national top-down style was replaced with a local top-down, bullying style, which can be even worse. I can remember the shock I felt on reading the first Francis report’s finding that,
	on receiving FT status, one of the first things that the Mid Staffs board did was to resolve to hold more meetings in private. That was an audacious breach of the spirit of the legislation passed by this House.

William Cash: The shadow Secretary of State and I have been engaged on this issue for a very long time. Will he admit that it was totally unacceptable for him and his predecessor to refuse to have a public inquiry, which I demanded relentlessly, under the Inquiries Act 2005? Does he agree that it was wrong to give foundation trust status when it clearly should not have been given, and does he accept that I raised the issue of gagging orders and confidentiality in a health debate in 2009, not 2010?

Andy Burnham: Foundation trust status was not a matter for Ministers. It was a job for Monitor, so it has to answer that concern. The hon. Gentleman is right that we had many discussions about a public inquiry. He will remember that in July 2009, two months after I was appointed Secretary of State, I brought in Robert Francis QC to conduct an independent inquiry into what happened. I did not order a full public inquiry and I will explain the reason why later.
	The difficult thing about the fact that the Mid Staffs board was holding more meetings in private was that we in this House had passed up our powers to intervene to stop it. That is another lesson we must learn: that the FT reform was naive in thinking that local autonomy would lead to improvement in all cases. In a national health service, there are areas where national direction is needed, and when things go wrong, there must be immediate powers of intervention, which, on my arrival in the Department in June 2009, I found I did not have. Foundation trust policy needs to be reviewed and adjusted to mitigate those dangers, including through a reconsideration of the power to de-authorise a failing foundation trust, which was recommended by the first Francis report, but repealed by the Health and Social Care Act 2012.
	We also need to consider targets and how they are used. Targets helped to deliver the lowest waiting times in history and that must not be forgotten. However, in places, they reinforced negative management practices. In focusing on only part of the patient experience, there was not sufficient focus on the overall patient experience and the whole person—a particular problem when it comes to caring for very elderly people whose needs are a blur of the physical, mental and social.
	Robert Francis is right to call for a fundamental rethink of the way in which we care for older people, and I have put his recommendations at the heart of Labour’s policy review. However, there are more immediate things that we can do and I will spend the rest of my time on five substantive points.

Bernard Jenkin: Will the right hon. Gentleman give way?

Andy Burnham: I will make some progress.
	The first point is about implementation. I would like to take this opportunity to thank Robert Francis for his work on this inquiry and the previous inquiry, which
	I commissioned. Robert Francis has taken the best part of three years to consider these matters in detail and has made 290 measured and proportionate recommendations. The people affected by these events should reasonably be able to expect that they will be implemented without delay.
	Today, I make a genuine offer today to the Secretary of State. If he brings forward proposals, he will have our support in speeding up implementation. I say that because I am becoming concerned about the timetable for the Government’s response. On 6 February, the Prime Minister told this House:
	“We will study every one of the 290 recommendations in today’s report and we will respond in detail next month”.—[Official Report, 6 February 2013; Vol. 558, c. 281.]
	Since then, the Government have commissioned a review of the recommendations, which is due to report in July. Although, like the hon. Member for Bristol North West (Charlotte Leslie), I have great respect for Don Berwick, I am surprised that the response to a long public inquiry is to set up another review. Is it still the Government’s intention to respond in detail this month? Although I welcome this debate, it is narrow in focus, so will the Secretary of State consider having a full day’s debate in Government time? Instead of more delays and reviews, we need action and a timetable for implementation. I would be grateful if the Secretary of State would respond to my offer today.

Nicholas Soames: Will the right hon. Gentleman give way?

Andy Burnham: No, I am making some progress.
	The second area where more transparency and accountability is urgently needed is on staffing levels. If the Government are not yet able to commit to all the recommendations, I ask them to expedite their response to Robert Francis’s important recommendation on patient-staff ratios. The board of Mid Staffs embarked on a dangerous programme of staff cuts, and yet public and staff representatives had no outside guidance to challenge it. The chief nursing officer said yesterday that staffing should be a local decision. Surely the lesson of Mid Staffs is that there is a need for much clearer national standards and guidelines, as suggested by the Francis report?
	This week, the Care Quality Commission reported that one in 10 hospitals in England and, worse, one in five learning disability and mental health services do not have adequate staffing levels. Surely that should ring alarm bells in the Department as it suggests that parts of the NHS are already forgetting the lessons of the recent past.
	The third area on which we need a clear statement from the Government today is the accountability and transparency of all organisations providing NHS services. Under “any qualified provider”, the Government are persisting with their assumption that all NHS contracts should be open to full competitive tender. Despite a promise to rewrite the section 75 regulations that are being made under the 2012 Act, my reading of the rewritten regulations is that regulation 5 will not let doctors decide, but will in effect force clinical commissioning groups to open tender for contracts. That raises the prospect that there will be a significant increase in the coming years in the number of private and voluntary sector organisations providing NHS services.
	If we believe in transparency and accountability, surely they have to apply across the board and on a level playing field. The problem is that private and voluntary sector organisations are not subject to the same strictures on freedom of information and whistleblowing. If action is not taken, we face the prospect of a serious reduction in transparency and accountability. Our attempts to find out new information under FOI requests on providers selected under AQP have hit the brick wall of “commercial confidentiality”. I say to the Secretary of State that that is not good enough. Accountability and transparency must always be paramount, as the motion says.
	Will the Secretary of State require all providers of NHS services to adhere to FOI principles, and will he ensure that whistleblowers working in organisations that provide NHS services have the legal protections that he has announced today? I draw the attention of the Secretary of State to an early-day motion tabled by my hon. Friend the Member for Easington (Grahame M. Morris) on this subject, which has attracted the support of 109 Members.
	The fourth area on which the people of Stafford need openness and transparency is the future of their hospital. They will understandably be worried about the recent recommendation from Monitor that the trust should be placed into administration. People will recall, as I said to the hon. Member for Stone (Mr Cash) a moment ago, that I commissioned Robert Francis in July 2009 to conduct an independent inquiry. I know that many people, including the hon. Gentleman, wanted me to go further and order a full public inquiry, but I stopped short because I was concerned about the effect that that would have on the hospital and its viability.
	All of us in this House now have a responsibility to help this hospital heal. After all that they have been through, it would be highly unfair to the people of Stafford if, at the end of all this, they were to lose their hospital or their A and E. They deserve a safe and sustainable hospital and I hope that the Secretary of State’s response to Monitor’s recommendation will map out a way to achieve that.

Aidan Burley: rose—

Nick de Bois: rose—

Andy Burnham: I will give way one final time to the hon. Member for Cannock Chase (Mr Burley).

Aidan Burley: I represent the other constituency that is served by Mid Staffordshire NHS Foundation Trust. Is the right hon. Gentleman implying that it is the holding of a public inquiry that has led to the threat to Stafford and Cannock Chase hospitals?

Andy Burnham: No, that is not what I am saying. I commissioned a second-stage—[Interruption.] The hon. Member for Cannock Chase should listen to the answer. I commissioned a second-stage review before the general election after Robert Francis delivered his first-stage review to me. I simply said that I took that judgment because I was worried that if there was ongoing uncertainty about the hospital for a long period, it may affect its viability. I have seen the statements from Monitor that there is a concern about the future viability of the hospital. I am making an appeal, on a cross-party basis,
	to say that all of us owe the people of Stafford a safe and sustainable hospital. I hope that the hon. Gentleman would agree with that sentiment.
	My fifth and final point concerns staff morale.

Bernard Jenkin: Will the right hon. Gentleman give way?

Andy Burnham: No, I will not.
	This is a difficult time in the NHS. The chief executive of the NHS has described it as a period of “maximum risk” as it struggles with the simultaneous challenges of efficiency and reorganisation. Morale in the NHS is low and one thing is clear: patient care will not improve if it stays like that.
	The Secretary of State is right to speak out for patients when the NHS falls short, and he should always do that. However, statements should be fair and should recognise the good that the vast majority of staff do, day in, day out, and the pressure that they are under, which is not of their own making. That balance has been missing from recent Government statements. I say to the Secretary of State that hospitals and NHS staff are not coasting—far from it. They are working flat out, with some coping better than others with the pressure that they are under.
	Politicians need to do more than just point out the failings of hospitals and NHS staff. We all need to support them with proper staffing levels on the wards. We all need to support them to speak out, wherever they work. We all need to stop the reorganisations that distract them from patient care. Those are the lessons of Stafford. Today, let us all resolve to face up to them.

Jeremy Hunt: I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie) on securing this important and timely debate.
	We should start by remembering why we are having this debate. Truly shameful things happened at Stafford hospital. Patients were left unwashed for days, sometimes in sheets soiled with urine and excrement. Relatives had to take bed sheets home to wash them because the hospital would not. Patients with dementia went hungry with their meals sitting right in front of them, because no one realised or cared that they were unable to feed themselves. If we are to prevent that from happening again, accountability for what happened is vital. I will talk plainly about that, including about the role of Sir David Nicholson.
	At the outset, let me reiterate that the NHS is one of our most cherished institutions. We can be proud that for 65 years it has ensured that everyone is entitled to treatment, regardless of their background or income. We can be proud of the excellent treatment and care that is the hallmark of most parts of the NHS. Most of all, we can be proud of the front-line doctors, nurses and health care assistants who look after 3 million people every week, with dedication, commitment and compassion.
	If we love the NHS, we must be prepared to be honest about its failures, and to criticise me for doing so suggests, I am afraid, dangerous complacency from the right hon. Member for Leigh (Andy Burnham). The tragedy of Mid Staffs shows how the desire to celebrate success got in the way of speaking out when things went
	wrong, and if we are to prevent such things from recurring, we must never allow our love of the NHS to stifle our determination to hold systems and individuals to account.
	Where does that accountability lie? Sir David Nicholson has been the focus of much attention, and as a manager in the system that failed to spot and rectify the appalling cases at Mid Staffs, he bears some responsibility. As he said, the focus was lost, and he has apologised and been held to account by this House and many others. However, I do not believe that he bears total, or indeed personal, responsibility for what happened. He was at the strategic health authority for 10 months during the period in question, overseeing 50 hospitals at a time when his main responsibility was the merger of three SHAs into one. He consistently warned both Ministers and managers of the dangers of hitting the target and missing the point.
	It is just not true that if there had been no David Nicholson at the SHA, there would have been no Mid Staffs; others bear far more direct responsibility and the Francis report tells us who. It makes it clear that the primary responsibility for what went wrong lies with the board of the trust. Astonishingly, members of that board seem to have melted into thin air, some moving to other jobs in the system, and others receiving generous payoffs.

William Cash: As my right hon. Friend knows, I do not agree with his assessment of Sir David Nicholson in this context. There was a systems failure that affected not only Staffordshire but the entire health service, and that lies very much at the heart of the problem. In my speech I will quote some statements made by Sir David at a conference a few months ago.

Jeremy Hunt: I obviously take on board what my hon. Friend says, but I want to move on to other aspects of the report.

Nicholas Soames: rose—

Jeremy Hunt: I shall give way on that point, and then I will make some progress.

Nicholas Soames: I am grateful to the Secretary of State. May I follow up on one point that he raised? He said that a number of those managers have disappeared or melted away to other jobs in the service. Does he agree that whatever else happened, there was a monumental failure of leadership at many levels, and that it is a failing of public services in this country—and the national health service in particular—that failing managers are too often recycled through the service to the great and constant cost of patient care?

Jeremy Hunt: I absolutely agree with my right hon. Friend. We will respond to the Francis report this month, as the Prime Minister has committed to do, and make plain measures to ensure that the situation cannot continue. My right hon. Friend is right to raise that point.

Bernard Jenkin: rose—

Jeremy Hunt: I will make some progress and then I will take more interventions.
	My response will detail how we intend to restore accountability to the boards of hospitals, and today I have removed the ability of any hospital to insert gagging clauses on patient safety in compromise agreements made with senior staff. My hon. Friend the Member for Bristol North West asked whether that will be retrospective, and I have written to all trusts to remind them of their responsibilities towards whistleblowers in respect of contracts and compromise agreements already signed. If we are to protect patients, we need an atmosphere of openness and transparency in the NHS—something to which the motion rightly refers.

Several hon. Members: rose—

Jeremy Hunt: I will make some progress and then I will take interventions from both sides of the House.
	Sir David Nicholson told the Health Committee last week that in the NHS as a whole, patients were not the centre of the way the system operated. Which party was in power when that culture was allowed to operate? If Sir David has been held to account, so too must the Labour party be held to account. The Francis report rightly states that Ministers were not personally responsible for what happened at Mid Staffs, and I have no doubt that no Labour Minister would have condoned, knowingly allowed or wanted the events at Mid Staffs to happen. We also know from the report that the pursuit of targets at any cost was a central driver of what went wrong. As the report set out, above all Mid Staffordshire NHS Foundation Trust failed to tackle an “insidious negative culture” involving a tolerance of poor standards and a disengagement from managerial and leadership responsibilities. It went on:
	“This failure was in part the consequence of allowing a focus on reaching national access targets,”.
	Ministers, not civil servants, are ultimately responsible for the culture of the NHS, and it is clear that during that period a culture of neglect was allowed to take root in which the pursuit of targets at any cost compromised the quality of care that patients received, and made it harder for front-line staff to treat people with dignity and compassion.

Andy Burnham: I am listening carefully to the Secretary of State but it is not fair to people in the NHS for him to say that Stafford equals everywhere in the NHS, and that we can take one failing—a terrible failing, as I said in my speech—in a locality and apply it to the whole NHS. He must acknowledge that NHS staff did an incredible job to end the situation when people were spending months and years on waiting lists, and even dying on them.

Jeremy Hunt: I acknowledge the brilliant work done by NHS staff and, contrary to what the right hon. Gentleman says, I do that in every speech that I make on these matters. I will not, however, accept the complacency that says that problems at Stafford hospital were localised and happened only in one place. If we are to sort out those problems, we have a duty to root them out anywhere in the NHS that they occur.
	The right hon. Gentleman talked about waiting times targets. Let us be clear: there is an important role for targets in a large organisation such as the NHS. Without the four-hour A and E target, or the 18-week elective
	waiting time target, access to NHS services would not have been transferred and I accept that the previous Government deserve credit for that. It was right to increase spending on the NHS, although it is curious that Labour now wants to cut the NHS budget. Labour did however—this is where Labour Members should listen rather than barrack—make three huge policy mistakes, and the right hon. Gentleman must accept that it is not simply a question of Government policy not being implemented in every corner of the NHS. Those three mistakes contributed to the culture of neglect that we are now dealing with.
	The first mistake—a huge mistake—was that Labour failed to put in place safeguards to stop weak, inexperienced or bad managers pursuing not only bureaucratic targets but targets at any cost. That is exactly what happened at Mid Staffs, where patient safety and care were compromised in a blind rush to achieve foundation trust status. Secondly, Labour failed to set up proper, independent, peer-led inspections of hospital quality and safety that told the public how good and safe their local hospital was. Instead of a zero-harm attitude to patient safety, we have a culture of compliance and the bureaucratic morass that is the current Care Quality Commission. Thirdly, Labour failed to spot clear warnings when things went wrong. The Francis report lays out a timeline of 50 key warning signs between 2001 and 2009. Why did Ministers not act sooner? If those warnings were not being brought to the attention of Ministers, why did they not build a system in which they were? Instead, there was a climate in which NHS employees who spoke out about poor care were ignored, intimidated or bullied.

Alan Johnson: The Secretary of State is making an interesting speech and there is no way that the Labour party can escape criticism for what happened at Stafford. Does he accept, however, that before 2000 there was no independent regulation of the NHS and no standardised mortality ratios, complaints in hospitals stayed in the hospital and there was no recourse to any independent observance of those complaints, and A and E—a particular problem at Stafford—was a data-free zone?

Jeremy Hunt: I accept that progress was made in the collection of data and that the previous Government set up a star rating system. The problem, however, was what it measured. It did not measure the quality of patient care but basically focused on access targets. It was possible for a hospital to get a three-star rating by transforming its 18-week access targets, even at the expense of patient care.

Stephen Barclay: It is correct that improvements were made in the collation of data. In fact, the Dr Foster data were published in national newspapers from 2001, but what is remarkable is that they were not acted on. That is the central charge for Ministers. We were the world leader in the collation of mortality data. We had the data, but Ministers did nothing with them.

Jeremy Hunt: My hon. Friend speaks wisely. Hospitals display 1,400 different pieces of data, but the question is why nothing is done when the data give dangerous messages.

Several hon. Members: rose—

Jeremy Hunt: I will make some progress.
	The question the right hon. Member for Leigh needs to answer is why he refused 81 separate requests to set up that public inquiry. He says that he did not want to distract the hospital from the essential task of making immediate improvements, but does he now accept that if he wants people to take his party seriously on NHS accountability he needs to apologise? That was a mistake. Until we have a proper apology—not just for what happened, but for the catastrophic policy mistakes made by his party—no one will believe that Labour would not make the same errors of judgment again. On the Government Benches, we are clear that accountability, dignity and respect for patients, particularly vulnerable, older people who are unable to speak out for themselves, must be embedded in every corner of the NHS.
	We will announce measures to set up a proper, independent peer review inspection regime led by a new chief inspector of hospitals that will not simply look at targets, but make judgments on whether hospitals are putting patients first. We will set up a single failure regime, where the suspension of the board can be triggered by failures in care as well as failures in finance; a patient-centred culture, by making the friends and family test a key part of the hospital inspection regime; clinically led commissioning, so that key decisions are made by people who see patients in their own surgeries; and an overhaul of the hospital complaints procedures led by the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart. We will do that with the minimum of upheaval. It is worth emphasising that Robert Francis himself says that the changes he calls for can largely be implemented within the system that has now been created by the new reforms.

Several hon. Members: rose—

Jeremy Hunt: I am going to make some progress.
	This debate is about accountability. I have been doing this job for six months, and in nearly every exchange on the Floor of the House, the Opposition have avoided engaging in substance, preferring instead to make baseless allegations about the Government’s motives in respect of the NHS. I put it to the House that we have shown our commitment to the NHS time and again through a protection of the budget; a willingness to face up to big challenges, whether in clinical commissioning, the funding of social care or the need to ensure that care is prioritised throughout the system—

Andy Burnham: Will the right hon. Gentleman give way?

Jeremy Hunt: No, the right hon. Gentleman needs to listen to my point. If Labour is truly committed to the NHS, it, too, has to show that it has learned. I did not hear that in his speech. Labour Members need to accept that they made some terrible policy mistakes that led to a culture of neglect. They must recognise that the party that claims to speak for the most vulnerable in society betrayed many vulnerable people, with tragic consequences. Only then will the public know that the lessons of Mid Staffs have been learnt—not just by the NHS, not just by civil servants, not just by Government, but by all sides of this House.

Several hon. Members: rose—

Lindsay Hoyle: Order. I remind Members that there is a seven-minute limit.

Rosie Cooper: I welcome the opportunity to speak in this debate on our national health service. I resolutely believe that we should have an open and honest debate on how we can each contribute to restoring faith in the national health service, and that we should not play politics with the findings of the Francis report.
	Increasingly, there is a deeply concerning creeping veil of secrecy across the public sector—local government, education or health. The application of greater accountability and transparency is the solution, ensuring that the interests of the public remain the singular and overriding number one priority in public service delivery. As a society, we display a huge and deep faith that the NHS is intrinsically good, and we want unquestioningly to believe that at all times it is acting in our best interests. The findings of the Francis report, as they should, shake that faith and belief in the NHS to its very core. Francis should be commended for his report—an extensive and comprehensive forensic examination of Mid Staffs and the structure of the NHS.
	I will be as brief as I can and focus on one tiny element: listening to patients, the people who pay for the NHS, and hearing what they are saying and acting on it. We do not need to keep on looking for a black cat in a dark room. Switch the light on! It is no good the Secretary of State simply repeating that we must listen to patients and their families. What assurance does he have that, until the next crisis, they are listening? In hearing after hearing of the Health Committee, senior people associated with the NHS trot out that the regulator is responsible and that the Care Quality Commission needs to deal with it. I never, ever thought I would feel sorry for the CQC, but, when everyone else ducks, it is supposed to catch the ball. We do not need to create another bureaucracy; we simply have to make work—really work—something we already have by giving it real teeth and enough resources to make it effective.
	I agree with the comments of Dame Julie Mellor, the parliamentary and health service ombudsman, when she said that she hoped that the Francis report
	“will trigger a debate that will support our view that good complaint handling should be at the heart of the NHS.”
	From front-line experience, I believe that to be both true and essential. During my time as chair of Liverpool Women’s hospital, a standing agenda item at the public monthly board meetings was a summary of all complaints received that provided an overview—not in minute detail, but an overview—of each complaint and the outcome: upheld or not upheld. Most importantly, there was a column that stated what action was taken. Employing this system of regular review ensured that the board had oversight, asked questions, could spot trends, be assured that action was taken and demonstrate to patients and their families that they were being listened to.

Nick de Bois: Does the hon. Lady accept, notwithstanding the efforts made in the hospital she mentions, that when MPs take up complaints on behalf of constituents and try to get to the truth behind them, we are faced with tremendous bureaucracy and resistance?

Rosie Cooper: Yes, and if MPs have problems, god help members of the public and patients.
	We had to demonstrate that we were really listening to patients. The medical and managerial staff had to take ownership and responsibility for complaints. They knew that at each board meeting they could be questioned and challenged. If we accept that there are large parts of the system that work well and focus our time and resources on areas that do not, we can raise standards and tackle deep-seated problems. As chair, I sought to build in assurance and be transparent about complaints; to solve them, not hide from them, and ensure that everyone was accountable right up through the management structure. I never believed in no blame; I believed in fair blame. Each time a problem was resolved properly, we became a better hospital. We were rightly proud that on the front page of the Liverpool Echo it was called an NHS gem. Sadly, the main board’s complaints report stopped after I stepped down as chair.
	We do not need to reinvent the wheel or have more reorganisation in the NHS, but we must make the complaints system work. From that important but simple action, culture changes happen and become embedded in the organisation. We then have real change, real transparency, real openness and real accountability—something we can all be proud of.

Barbara Keeley: A complaints system sounds very useful. When staff knew that complaints were being assessed and reported on every month, what impact did it have on them?

Rosie Cooper: In essence, it encouraged a change of culture. They were not operating in a vacuum, where patients did not matter and where the complaint might not ever get resolved—where, if a manager said it was okay, it disappeared. The fact that the light was switched on and that people could ask questions was valued.
	There is a huge disconnect between the rules and the enforcement of rules. When local resolution fails there must be another, proper avenue for patients to appeal that decision: just having the NHS investigate the NHS is not the way to improve the health service, or patients’ confidence in it. Currently, the message we send out is that unless people have the financial resources to fight the system in the courts it is easy for families and patients to be ignored.
	Chief executives and boards know that the ombudsman investigates only a tiny proportion of the cases referred to it, and it is not as feared as it should be. I say to the Secretary of State that we need an ombudsman service that is properly resourced, has the necessary investigative powers and sanctions, and makes public in its reports its findings to everybody who pays for the NHS, not just to Ministers. Being able to name and shame in the spirit of openness and transparency will be a powerful tool, especially when, in these times of foundation trust hospitals competing to attract business, reputation is the key.
	Given that all hospitals will eventually become foundation hospitals, is the Secretary of State willing to say that foundation hospitals will have to report all their statistics openly and that every board meeting should be a public meeting? There should be no hiding; there should be openness and transparency right across the NHS. The light needs to be switched on not just in individual rooms but in the NHS, full stop.
	I have on the wall of my constituency office this quote from an editorial in the Liverpool Echo:
	“Doing the right things does not automatically follow saying the right things”.
	At present, everyone in the national health service is saying the right things. What assurance can the Secretary of State give us that the NHS will do the right things? Frankly, the public do not want any more politics from anybody. They do not want warm words or excuses; they want actions that will lead to real change. No more big reorganisations; we just need to make a difference. He must listen to the people’s complaints. Actually, in Mid Staffs the complaints could not have been any louder.
	I said to the hon. Member for Bristol North West (Charlotte Leslie) earlier that we cannot keep on saying that it is somebody else’s fault, that somebody else should be held accountable and that somebody else is going to supervise. This goes to the core of the Department of Health. If we listen to the people and give the ombudsman—the right person for the job—the powers to deliver, we will see a culture change.

Stephen Dorrell: I want to follow the hon. Member for West Lancashire (Rosie Cooper) on to very similar territory. She and I both sit on the Health Select Committee, which I chair. I want to start where my right hon. Friend the Secretary of State and the right hon. Member for Leigh (Andy Burnham) started, with what happened in Mid Staffordshire. It was shameful, and we will be judged today by whether we show a serious willingness to learn and apply the lessons of the Francis inquiry.
	Francis made 290 recommendations, but they amount to just one core recommendation, which is that there needs to be a fundamental culture change through the whole of the national health service. With respect to the shadow Secretary of State, that is the sense in which challenges are posed for the health service way beyond Staffordshire. We have to learn the lessons of Staffordshire and apply them beyond it, as well as demonstrating that we understand what we mean—in the modern jargon, we “get it”—when we talk about the need for a culture change.
	My hon. Friend the Member for Bristol North West (Charlotte Leslie) encapsulated that when she used the words “accountability” and “transparency”. I will not follow her down the route that she took in her speech. I want to focus exclusively on what we mean by those two words. They seem to trip too easily off the tongue, without anyone understanding what they mean, and that must change if we are to sustain a culture change in the health service.
	My first proposition is that accountability without transparency is entirely meaningless. The ability to see what is going on and how decisions are being made in the health service, and to see the effects of those decisions, is fundamental to the delivery of the objective of culture change. With respect to the right hon. Member for Leigh—and, indeed, to some of the points that my right hon. Friend the Secretary of State made—we have to acknowledge that a lack of transparency lies deep in the culture of the health service, and that it goes back to way before the previous Government were in office. It was present in my time as Secretary of State and well before that, too. I was regularly accused of supporting a
	gagging culture in the health service, although nothing could have been further from my intention. However, that charge was made against me, against the right hon. Members for Leigh and for Kingston upon Hull West and Hessle (Alan Johnson) and, in truth, against all our predecessors right back to 1948.
	The instinct to protect, rather than the instinct to reveal, is deeply embedded in the health service. When something is said to be going wrong, there is an instinct for the wagons to gather round. That is why Francis’s recommendation for a duty of candour is key to the delivery of the objective of greater accountability and transparency.

Barbara Keeley: Was the right hon. Gentleman as disturbed as I was to hear that the £500,000 gag at the United Lincolnshire Hospitals NHS Trust was put in place without any sign-off whatever, on the basis that it had involved judicial mediation? The Secretary of State refused to answer my question about this. Does the right hon. Gentleman agree that the Secretary of State really has to stop that, because it involved a very large amount of money, which was used very ill-advisedly?

Stephen Dorrell: The position I take is the one set out in the Francis report, which was explicitly endorsed by Sir David Nicholson in the Select Committee inquiry to which the hon. Lady has referred. I believe that it would also be endorsed by my right hon. Friend the Secretary of State, but he must speak for himself. That position is that it is hard to imagine circumstances in which the use of public money in the context of a compromise agreement should be governed by a confidentiality clause. In an age when a bill from Pizza Express has to be published on the internet, decision makers should be held publicly accountable for the use of large sums of money in the context of a compromise agreement.

Bernard Jenkin: I accept my right hon. Friend’s challenge about openness and transparency in the way the health service reacts outwardly, but that is a means to an end. There is also a lack of honesty and openness between people working in the health service, and the mistrust between levels of management and institutions inhibits the proper flow of information and the ability of people to trust each other in the context of saying what is wrong and putting it right. People in the health service dare not tell their senior management what is wrong.

Stephen Dorrell: I have a lot of sympathy with what my hon. Friend says. The successful delivery of a culture change that supports real transparency would build on the fact that it is not only a right but an obligation for a registered doctor or nurse who sees care being provided that falls below proper standards to raise their concerns and, if no action is taken, for those concerns to be raised with the regulator. Change will be required right through the health service if that professional obligation is to be made real.

John Pugh: My right hon. Friend has mentioned the instinct to protect and to circle the wagons. Would he accept, however, that that is not exclusive to the NHS, and that it also exists in the police service, for example? It also existed in Parliament during the expenses scandal. It is an institutional feature of many kinds of organisation.

Stephen Dorrell: I agree with my hon. Friend, but I hope he will forgive me if I do not follow him down the road to the police service in the three and a half minutes I have left.
	My key objective is to enable Members to recognise that this is a deep-seated cultural issue, that we need to create a more open culture, and that a duty of candour is fundamental to that. I say to the right hon. Member for Leigh that we need to ask ourselves occasionally: accountable to whom? Surely in the first instance, the health service must be accountable to the patient. How can it ever be right for a failing in care provision that has been acknowledged and discussed not to be described to the patient? That duty of candour to the patient is fundamental to the culture change that I am describing. However, we have to remember that, within the tax-funded health care system, there is a duty not only to the patient but to the taxpayer. Although I do not want to go too far down this road, the challenge for the right hon. Member for Leigh when he speaks about competition and decisions about the use of public money is that commissioners and providers must be accountable for value as well as clinicians being accountable for quality.
	In my remaining time, I want to pose this challenge for those elected to this House. The challenge of culture change has to apply right through the health service, but people looking into this debate from outside will, I suspect, conclude that thus far that challenge has not been fully responded to. There is a deep-seated culture here that pretends that the problems all started under this or that lot, or that every success is the result of achievements made by one particular side, but the truth is that this deep-seated requirement for culture change has been addressed by successive Governments over a protracted period.
	We should not forget that waiting time targets were invented before I was Secretary of State for Health. Quality of care requires access to care as well as to high-quality clinical outcomes. We should not forget that deep in the pathology of what happened in Staffordshire, the health economy there was out of control. It was running sustained deficits and management was required to bring that health economy under control. There is no choice between quality on the one hand and management on the other. We need to develop a culture within the health service that allows managers to address questions of both quality and value because unless we address both, we will deliver neither. That is the core challenge facing the health service over the period ahead.

Kate Hoey: It is a pleasure to follow the right hon. Member for Charnwood (Mr Dorrell), who speaks with a breadth of experience and history in the national health service, and I congratulate the hon. Member for Bristol North West (Charlotte Leslie) on securing this long debate, providing an opportunity to all of us to say a few words.
	I agree wholeheartedly with everything my hon. Friend the Member for West Lancashire (Rosie Cooper) said, particularly about what seems to me, too, to be a growing public body desire for secrecy. This is happening not in the national health service alone, but in many other bodies. Indeed, as my hon. Friend well knows, it is happening in this House. I am concerned about a number of issues—how staff are treated, getting rid of the
	telephone exchange and a whole number of other decisions taken up there somewhere. We, as Members who work here, have very little say.
	It is important for us to remember the Nolan principles of public life to which every public body is meant to sign up—accountability, openness, honesty and leadership. I do not want to say much specifically about what happened in Mid Staffordshire, but it was appalling. As someone who has had a good and well-led hospital in my constituency for many years, I find it almost unbelievable that all that could have happened in the Mid Staffordshire hospital with so few people seeming to know what happened or to speak out about it. Then, when it was pointed out, no one listened. That provides a terrible warning about what can happen. We all think that we know what is happening in our constituencies, but we do not always, as this episode has shown.
	Let me talk about my local hospital Guy’s and St Thomas’, King’s College hospital and SLAM—the South London and Maudsley hospital. What has been called the “King’s Health Partners” has sought to bring together the research work at King’s College medical school with others, and the body is now growing to be almost an entity in itself, making decisions, sending out publicity and getting further and further away from the foundation trust.
	Looking back to when my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) was Secretary of State for Health, some of the decisions he made in the Health Act 1999 were more about accountability than anything that has been done since by any Government. For example, he instructed NHS chairmen to hold their board meetings in public, while non-executive directors were required to live in the area served by the trust—a crucial step that fundamentally changed St Thomas’ hospital when we had a local chairman who knew the area, was involved in the hospital and cared about it. She spent all her time as chairman wandering around the hospital trying to find out about everything that was going on: she was accountable to everyone. That was crucial to the public, too, as they knew that they had people on the board who knew what was happening in the locality.
	I believe that one of the first responsibilities of non-executive directors—they are not part of the management —is to visit the wards, to talk to patients, to collate local concerns and to talk to MPs, local councillors and the local authority. That was always happening. We had a very good system. There were concerns about the treatment of the elderly at one stage in one of the wards for elderly people at St Thomas’, but they got dealt with very quickly because we had a responsive chairman and a responsive board. A lot of that happened when my right hon. Friend the Member for Holborn and St Pancras was the Secretary of State. The Health Act 1999 also gave the chief executive officer absolute personal responsibility for clinical governance standards—another important reform—in addition to the responsibility to be the accountable officer.
	Later we had foundation trusts, although I have to say that I did not vote for them. I have had a well-led foundation trust up to now, but I did not feel that this was the right way ahead for the national health service at the time. We have got them, however, and some foundation trusts saw fit to erode the principles as financial considerations took precedence over clinical standards on many board agendas. The foundation trusts still remain the chief executive officer’s responsibility.
	One thing the King’s Health Partners are doing in the name of foundation trusts is steamrolling ahead to bring about a merger of Guy’s and St Thomas’ hospital, which is a huge trust, King’s College hospital, which is another huge trust, and the South London and Maudsley trust. It is believed that the merger will somehow lead to a “world-class”—I do not know how many times Members have heard the term—hospital.
	I am furious and angry—as are, I think, all five of the MPs representing the area at how this merger has been handled. The lack of openness has been appalling and there has been no public board meetings or disclosure of information about the proposed changes. The proposals have been either badly put forward or not put forward at all. The board at St Guy’s and St Thomas’ has an occasional surreal meeting as a showcase for public involvement, but it never discusses the real issues. It opens meetings for the public only when it suits the board.

Lyn Brown: Does my hon. Friend agree that the plans for reorganisation of the trusts south of the river need to be put on hold?

Kate Hoey: That is precisely what the five Members of Parliament have asked for. Recently, on 28 February, we heard from the chairman of Guy’s and St Thomas’, who was previously a permanent secretary at the Department of Health. That takes me back to one of my earlier points about people moving around within the health service. It is always somebody who has been someone else in somebody else’s patch that gets a job with another NHS trust. This chairman wrote to say that the project is forging ahead with a full business case. William McKee, who brought together trusts in Northern Ireland, has been appointed and we are told that he is going to spend at least £5 million to bring about the business case to show why this will be such a wonderful idea. The right hon. Member for Bermondsey and Old Southwark (Simon Hughes) and I have written back asking who is actively responsible, how the money from the different bodies is being allocated, what the precise budget will be and how it will be spent by whom. The whole accountability thing is there in a nutshell. Who is actually accountable? Does the Secretary of State have any say whatsoever? No. Apparently he is only interested if the move will clearly not be good for patients in clinical terms.
	I know that the establishment of such a large trust will be totally against the interests of people. Trusts cannot operate on such a large scale. One chief nurse cannot be responsible for all those hospitals.

Phillip Lee: As ever, it is an honour to follow the hon. Member for Vauxhall (Kate Hoey).
	Let me begin by congratulating my hon. Friend the Member for Bristol North West (Charlotte Leslie) on securing a debate about this important subject. It is a subject that I think should be debated more often in the Chamber, and I find it surprising that fewer Members wish to speak about it than have wished to speak about some of the other issues that we have considered since Christmas. I think all Members should reflect on that.
	I believe that the core of this problem is responsibility: responsibility in public life. The general public are fed up—not increasingly fed up, but completely fed up—with
	hearing about scandal after scandal involving the national health service, the BBC, the newspapers and so on, for which no one takes any responsibility. No one walks. No one looks at themselves in the mirror in the morning and says “I did not do as well as I should have; I am paid a decent wage; the honourable thing to do is resign”—not “be sacked”, but resign.
	I do not want to make a speech about Sir David Nicholson. Sir David Nicholson should know that he ought to resign. I cannot comprehend how he can think that his position is sustainable from a moral standpoint, but if no morality is involved, what about competence? He may have been head of the strategic health authority for only a relatively short time, but he was aware of the mortality rates when he was in that job. What did he do about it? If he did nothing about it, why is he still in post? However, I do not want to make this a personal issue.
	Having worked in the national health service for 13 or 14 years, I do not need to be told about the problems caused by the culture in that institution. I learnt how it was as a medical student, and I saw it at first hand as a junior doctor. I want to say something about that, and also about competence in general. We need competent individuals in charge of our hospitals and on hospital wards, but I am not sure that we have had them in recent years. I also want to say something about responsibility in the light of that.
	The national health service is a huge institution—some might say too huge—and because of its size, the fact that it has grown over the past 60 or 70 years, and the fact that the people who work in it rarely leave, institutionalised behaviour is rife. It is rife in medicine and in management. In my view, former Secretaries of State on both sides of the House display such institutionalised behaviour themselves. They may wish to reflect on that at the end of the debate.
	The first debate in the House in which I spoke, apart from the debate during which I made my maiden speech, was a Backbench Business Committee debate about compensation for haemophiliacs. I was struck then by the institutionalised response from the Department of Health. It seemed plain that the Department did not want to set a precedent by doing what was obviously the right thing, namely compensating about 4,000 people and their families for what the system had done to them.
	I am therefore not surprised by the Francis report, which those who read it will discover to be a not particularly impressive document. Parts of it have the ring of a Nuremberg defence. It is remarkable that individuals cannot be held responsible for their actions within a system. That system is apparently so perfect that no one within it needs to be good. I think that we need a health service in which individuals, including Secretaries of State, take responsibility for their decisions at every stage.

William Cash: Was my hon. Friend surprised, as I was, that neither of the Secretaries of State who were in charge at the time were called to give evidence to the inquiry? Did he find that very strange?

Phillip Lee: I did find it very strange. In fact, I find the behaviour of both former Secretaries of State strange all round. There is a constant blaming of—

William Cash: May I just correct one thing? The shadow Secretary of State was called to give evidence, but not the previous two Secretaries of State.

Phillip Lee: I am talking about those who were Secretaries of State in the last Administration. In response to an intervention during his speech, the right hon. Member for Leigh (Andy Burnham) said, “I passed it on to Monitor.” The attitude that leads people to push away the process of decision making and take no responsibility for the outcomes needs to end.

Andy Burnham: Surely, as a clinician, the hon. Gentleman would resent the idea of politicians’ interfering in the independent clinical regulation of hospitals. I did not do nothing. Within days I had asked the Care Quality Commission to investigate the outliers that Brian Jarman had given me. I will not sit here and accept the hon. Gentleman’s suggestion that I complacently did nothing. That is not true, and he should not repeat it in the House.

Phillip Lee: Despite that, nothing changed, did it? The CQC has a terrible reputation in my profession, and to have handed the matter over to it—when it was run by someone who was implicated at Mid Staffordshire—is not a defence.
	Let me broaden the discussion to something that I may know something about: practising medicine in organisations run by the Department of Health. I can tell the House that the prevailing atmosphere is one in which attention is not drawn to problems. There is a fear for jobs down the line. Let me give an example. When I was a junior doctor, I misused a photocopying machine in a hospital. Within hours, I received a phone call from a middle-grade doctor telling me that if I did that again, it would affect my reference. The phone call, I was told, had been authorised by the then consultant general surgeon at St Mary’s, Ara Darzi. I reflected on that at the time. It made me feel rather intimidated. [Interruption.] The prevailing mood in hospitals was that seeing or doing something wrong could adversely affect a person’s future career.

Charlotte Leslie: Does my hon. Friend share my regret that Opposition Members are groaning in that way? What he is describing has been very evident for very many years. One need only speak to a doctor to learn that there is a culture of fear. Nearly every doctor knows someone who has tried to speak out against something that has happened. People know that if they do that, there will be counter-allegations against them. The groaning and expressions of surprise from Opposition Members are very sad, because it reveals just how little they were actually talking to clinicians on the ground who have been complaining about this for a decade. I received an e-mail from the spouse of a clinician who said that over the past 15 years the management styles encouraged by the previous Government had made that clinician ill.

Phillip Lee: Of course my hon. Friend is right.

Rosie Cooper: Will the hon. Gentleman give way?

Phillip Lee: I must get on, I am afraid. I do apologise.
	The point I am trying to make is that a certain culture prevails, and into that culture, or environment, the last Administration introduced targets. I do not suggest for one second that the last Administration thought those targets would lead to the type of care that was provided at Mid Staffordshire, but I am not surprised that there were adverse consequences, and I think Opposition Members should reflect on that.
	The final thing that I want to say about culture and competence concerns politicians. The right hon. Member for Leigh said that I would not want politicians to interfere in day-to-day care. Of course I would not, but I would like politicians to take responsibility for the service Let me give an example. There are only about 250 acute trusts in the country, and not that many mortality figures have to be looked at in each trust. It could be done on a monthly basis. However, I am told that it was not done by Secretaries of State in the last Administration. Why? If I were the Secretary of State, the one thing I would want to look at would be clinical outcomes in hospitals. If that is beyond Secretaries of State, one is prompted to ask why they are in post. If those figures had been looked at earlier enough, we might not be having this debate.
	Competence and the right culture are only possible with transparency. That is the most important aspect of this whole issue.

Alan Johnson: Well, there’s a man who knows all the answers!
	It was four years ago on Monday when I apologised to this House on behalf of the Government and the national health service for what happened at Stafford. We had just received the report from the Healthcare Commission, and I think it is fair to say that no one with any experience of the NHS could quite believe what had gone on. The people in charge at a time when there were unprecedented resources and investment being put into the NHS had cut staffing on A and E to such an extent that a receptionist with no medical training was triage nursing in A and E.
	We need a longer debate. There is nothing ostensibly wrong with the motion, and I agree with my right hon. Friend the Member for Leigh (Andy Burnham) that we should support it, but it is clear from the way it was moved and the last contribution that this is all about the blame game. If I can just quote Francis—[Interruption.] Yes, the hon. Member for Bracknell (Dr Lee) does not agree with Francis or with Ara Darzi and knows everything, and says that Francis was a Nuremberg—

Phillip Lee: rose—

Alan Johnson: No, I am not giving way—at least not to the hon. Gentleman. I have heard enough.
	This is what Francis said in paragraph 108 of his report:
	“To place too much emphasis on individual blame is to risk perpetuating the illusion that removal of particular individuals is all that is necessary. That is certainly not the case here. To focus, therefore, on blame will perpetuate the cycle of defensiveness, concealment, lessons not being identified and further harm.”
	So the man who knows most about what happened at Stafford hospital—and who was entrusted by this Government and their predecessors to conduct not one,
	but two, inquiries, and who in four volumes running to millions of words sets out what happened, why it happened and how it was allowed to happen—counsels against the very action that this motion appears to propose.
	Francis identified who was accountable, and the Secretary of State was absolutely right: it was the chief executive, the chair and the board of the Mid Staffordshire trust. A number of clinicians are also held accountable for the appalling lapse in standards of care at Stafford. This accountability regime is set out in legislation approved by this House.
	The Francis findings are consistent with those that emerged from the inquiry into the care of children receiving complex cardiac surgery at Bristol Royal infirmary between 1984 and 1995. In that case, five individuals at the hospital, including the chief executive, were the subject of adverse comments. In respect of both Bristol and Stafford, an argument was made to an inquiry that there was an extenuating failure of national policy. At Stafford, it was national targets; at Bristol, it was inadequate resources.
	It is worth recalling the Bristol inquiry’s response. Sir Ian Kennedy said:
	“The inadequacy in resources for PCS”—
	paediatric cardiac surgery—
	“at Bristol was typical of the NHS as a whole. From this, it follows that whatever went wrong at Bristol was not caused by lack of resources. Other centres laboured under the same or similar difficulties.”
	We must remember that these were the days when one in every 25 patients on the cardiac waiting list died before they could be operated on, and when somebody with a serious heart condition could wait a year to see the cardiologist, three months to see the consultant and then 18 months to two years for the operation. That is why targets had to be introduced—to get a grip on this awful situation.

William Cash: I am astonished by the line on accountability that the right hon. Gentleman. He was the Secretary of State and I had a row with him at the time—and, indeed, with his successor—about the question of holding a proper full public inquiry under the Inquiries Act 2005. I wrote to him, too, and I did not get satisfactory answers under the guidelines laid down in the 2005 Act on the prime ministerial rules issued by the Cabinet Office.

Alan Johnson: On the question of a public inquiry, when Francis reported on his first inquiry, commissioned by my right hon. Friend the Member for Leigh, he made the point that it was about people affected being able to come and tell their story, and Francis said in his first report:
	“I am confident that many of the witnesses who have assisted the inquiry in written or oral evidence would not have done so had the inquiry been conducted in public.”
	It is very important that that first inquiry allowed people to come forward. The right hon. Member for South Cambridgeshire (Mr Lansley) may also well have been right to make the second stage of that a public inquiry, which was authorised because of one of the Francis recommendations, because we now have all the information, provided before a Queen’s counsel, about what happened there.
	Francis is very clear about no blame being apportioned to any Minister. It is of course right for Ministers to be accountable if anyone knew what was going on and did nothing to stop it, or if something that was going on was a result of a Government edict or policy, but that was not the case at Stafford.
	Targets had to be introduced to get a grip on this terrible situation of lack of access to health care. Targets did not cost lives; they helped to save lives. They were accompanied by the resources, the capacity and the political will that transformed waiting lists of 18 months to two years to a maximum of 18 weeks and an average of nine.
	This is what Francis said about targets:
	“It is important to make clear that it is not suggested that properly designed targets, appropriately monitored cannot provide considerable benefits and serve a useful purpose…indeed the inquiry accepts that they can be an important part of the health system in which the democratically elected Government of the day sets its expectations of providers who are funded by the taxpayer.”
	The right hon. Member for Charnwood (Mr Dorrell) was absolutely right to say that long waiting lists have dogged the NHS since it was created in 1948. Rudolf Klein, the great historian of the NHS, says every Health Secretary shouted their orders from the bridge and the crew carried on regardless. Something had to be done to deal with that, and it was done.

Jeremy Hunt: Does the right hon. Gentleman not accept that the issue was not targets, but it was the failure to put in place safeguards to stop managers twisting a targets culture into a culture of targets at any cost? That was the fundamental policy mistake. The lack of those safeguards meant Mid Staffs could happen.

Alan Johnson: The Secretary of State is right. Of course there need to be safeguards to ensure any system has a backstop to stop people misusing targets. The guidance from the Department of Health was very clear. In no way must the pursuance of targets interfere with the need for good patient care. The Stafford chief executive must have translated that into saying it was fine to put receptionists on triage nursing. With all due respect to the Secretary of State, I do not think that he or any of his successors or predecessors can make regulations to meet every eventuality, including for someone like that chief executive of the Mid Staffs trust.

Charlotte Leslie: In some ways I agree with the right hon. Gentleman, in that I think targets and ensuring that things are happening is not the main cause of what went wrong. Does he agree, however, that targets along with what many medical professionals criticise as the de-professionalising of the work force through the consultant contract, the working time directive and the new deal was a toxic combination?

Alan Johnson: The principal point about targets is that they reduced waiting list times. They changed a situation in which people were dying while on waiting lists, which was a disgrace in a civilised country like ours.
	The Francis report also gives no comfort to those who expected him to offer up Sir David Nicholson’s head on a plate. The irony is that they choose to make this attack on an NHS that is learning the lessons of
	Stafford and an individual, Sir David Nicholson, who has done more than anyone to make quality of care the organising principle of the NHS. I, like my three successors as Health Secretary, consider Sir David to be part of the solution, rather than part of the problem He is not perfect—none of us are—but he is a good public servant who is committed to the NHS, its patients and staff. If he knew what was going on at Stafford, or colluded in the awful events there, or if any of his edicts, policies or pronouncements were in any way responsible for what happened, I would agree with his detractors. No one knew what was going on at Stafford; not even the press, who pride themselves on fearlessly exposing wrongdoing. Not a single question was raised by local MPs in this House about what was happening at Stafford, and Francis has something to say about the way they passed on complaints.

William Cash: Will the right hon. Gentleman give way?

Alan Johnson: No, and I read the hon. Gentleman’s correspondence and it in no way drew attention to what was happening at Stafford.

William Cash: rose—

Nigel Evans: Order. Please resume your seat, Mr Cash.

John Pugh: I congratulate the hon. Member for Bristol North West (Charlotte Leslie) on calling for this debate, which I want to widen and, I hope, put on a more consensual footing.
	I have a constituent whose grown-up son tragically died of leukaemia some time ago. He went to the doctor many times and was diagnosed as a young, healthy man with glandular fever. A blood test was made far too late, and he died. After the funeral, the mortified doctor wrote to the parents and apologised frankly for her failure and her error. There was no litigation or talk of system failure; there was simply a frank admission of individual human error and a sincere apology, which was accepted.
	In many cases of NHS failure, there is no one individual to blame, so people talk of systems and cultures, which we have talked about constantly today. No one individual can be held entirely to blame for the system, so it always seems that no one person is to blame or is prepared to take the blame—even those who manage and design the system, such as Sir David Nicholson.
	When a hospital performs badly, and the one in Mid Staffs is simply the most telling example, some of the reasons lie in external factors: in the targets imposed on it, in the requirements made of it—becoming a foundation trust is one it could have done without—and in directions that impaired it. The NHS reorganisation certainly got in the way, according to Francis. When outcomes are poor, it can be hard to determine exactly how to apportion blame and responsibility. Do we blame those who witnessed what went on and did nothing; those who failed to notice worrying trends; those who did notice them but covered them up; or those who could have intervened from on high but did nothing? In one sense, they are all
	responsible—and some are more responsible than others. But we live in a very harsh and judgmental climate, as was said earlier, and we forget that people at every stage have mixed motives—good and bad—for not kicking up a fuss, for covering up, for not intervening. Some are good—usually, they are bad—but in most cases institutional or personal reasons outweigh the concern for patients. There are quite legitimate fears that the hospital or branch will be criticised or seen as underperforming, which will be bad for morale in hospital, or that one’s career will be in jeopardy—a legitimate concern—or that one is getting a colleague into trouble. Institutional or personal goals get separated from the avowed patient-centred mission of the NHS. Frankly, that is all too human an outcome, and it has always happened to some extent. The NHS is full of very good people, but it is not yet staffed by saints. All of us at some time cover up for colleagues.
	However, we always try to find in an institution a way of correcting for this, which is why we have professional standards in the medical profession and an NHS constitution. It is why we need true accountability, good complaint-handling, protection for whistleblowers, duty of candour, the learning of lessons and, of course, proper redress. That is why we have had legislation on the NHS constitution and increased democratic scrutiny, introduced by both Governments, which I applaud. I am not entirely certain what has happened to the NHS redress Bill, but I applaud that too.
	However, we build other sorts of incentives into the system, and it is as well to record them. They appeal to a different aspect of human nature, a more selfish side, perhaps out of realism, perhaps because of an ideological conviction that that is how people work. We model hospitals on profit-making institutions. We make survival dependent on competition with other profit-making institutions, which have gagging clauses in their contracts for good reasons—their competitors. We try to modify clinician behaviour not always by appealing to clinical judgment, but by appealing to the pocket. Therefore, we should not be surprised if the moral atmosphere, at times, becomes a little cloudy. We, as legislators, are partly responsible for that.
	If we turn the NHS into a set of businesses united by a corporate brand, should we be surprised if occasionally, individual branches put their interests ahead of those of their patients, choosing to satisfy those who pay—the Government—rather than the patients they serve?
	There are many good things that we can do and would wish to do. We can make the complaints process easier. We can assign accountability better, so that an individual’s job and survival in an organisation depends on serving the patient, not on always doing what the institution necessarily requires. We can ban gagging orders, and I applaud the Secretary of State’s move in that direction. We can improve inspection, not by making it more ferocious—we do not need to do that—but by linking it better to improvement. Above all, we need to start thinking about what we want the NHS to be. If we are unhappy with the culture, exactly what sort do we want to have? Do we want the moral enterprise that Bevan envisaged—a contract on behalf of the hale and hearty, to protect the sick and vulnerable—or a set of businesses that sink or swim depending on how good they are at getting state funding? We can either rediscover the moral purpose of the NHS, or regard it as an
	organisation that brings to book from time to time the businesses that work within it, independently of the Secretary of State.
	Frankly, I know which I prefer, but I have to record that currently we exist in a strange kind of moral limbo. We are judging an institution that looks very different from the original NHS, according to the high standards and moral mission Bevan set. I have a lot of sympathy with the remarks of Harry Cayton of the Professional Standards Authority, who said in The Times only this week that the NHS must rediscover its “moral purpose”. We exist in a kind of moral fog, a state of limbo, and if we want to know who is accountable for that, it is us.

Jim Dowd: It is a pleasure to follow the hon. Member for Southport (John Pugh), who always makes thoughtful contributions.
	I congratulate those Members who tabled this motion, to which I was happy to add my name. I am grateful to the Backbench Business Committee for agreeing to this debate, but, like others, I feel that the issue is so important that it should be debated in Government time. However, I suspect that, in the light of developments, we have not heard the last of the issues raised by the Francis report. The Secretary of State outlined a few of the measures he is intending to bring before the House, so we will have opportunities for other such debates.
	I will not refer in any great detail to the Mid Staffs fiasco, serious though that is, and the obvious implications for other areas across the country. I want to concentrate on transparency, and to avail the House of the experience in south-east London of the tender mercies of the first, and so far only, trust special administrator, who was appointed to the trust next door to Lewisham—the South London Healthcare NHS Trust. That trust comprises the Princess Royal University hospital, in Orpington; the Queen Elizabeth hospital, in Greenwich; Queen Mary’s hospital, in Sidcup; and the Orpington hospital—although that was actually subject to a separate consultation.
	The then Secretary of State said in a statement on 12 July last year:
	“I wish to inform the House that I have made an order to appoint a trust special administrator to South London Healthcare NHS Trust…The regime, included by the last Government in the Health Act 2009, offers a time-limited and transparent framework to provide a rapid resolution to the problems within a significantly challenged NHS trust”—
	trust, singular. He continued:
	“The trust special administrator’s regime is not a day-to-day performance management tool for the NHS or a back-door approach to reconfiguration.”—[Official Report, 12 July 2012; Vol. 548, c. 47-48 WS.]
	On 13 July, he issued the order to give effect to those measures.
	I raise this as a transparency issue because the trust special administrator brought forward proposals that damage, downgrade, devastate, destroy—whichever word one wants to use—Lewisham hospital, which is a completely separate trust. The right hon. Member for Charnwood (Mr Dorrell), who is the Chair of the Health Committee and has great knowledge and experience of these matters, said that accountability and transparency are interlinked: we cannot have one without the other. I agree with him wholeheartedly, but that has not been
	the experience of the people in Lewisham: the TSA is entirely unaccountable. The TSA stands at the head of a disgraceful, disreputable conspiracy—launched in the Department of Health, aided and abetted by NHS London and handled in the most autocratic manner—to downgrade Lewisham hospital.
	The titles of both the orders issued by the Secretary of State, copies of which I have here, start with the words:
	“The South London Healthcare National Health Service Trust”.
	The order setting up the administrator states:
	“That draft report to the Secretary of State must state the action which the trust special administrator recommends the Secretary of State should take in relation to the South London Healthcare National Health Service Trust.”
	It contains no mention of anybody else, yet the Department now says, “Of course we needed to look at the whole of south London and the whole of the health economy of south-east London, because everything connects to everything else.” Well, that is true of everything in the whole wide world.
	From day one, all the documents of the TSA included the phrase “Securing sustainable NHS services”. One such document was headed: “Securing sustainable NHS services—Consultation on the Trust Special Administrator’s draft report for South London Healthcare NHS Trust and the NHS in south east London”. This House did not give the administrator that authority—the law does not provide for the administrator to look at the situation across south-east London—and he has acted beyond his powers.
	I come now to the most interesting thing, and I accept that the current Secretary of State has had this matter dropped in his lap. If this was always about the whole of south-east London, why when the former Secretary of State had a meeting in July to discuss this did he invite the Members who represented Bromley, Bexley and Greenwich—rightly, because they cover the South London Healthcare NHS Trust area—and the Members for Lewisham? One could say that it was because they were looking more widely. Of course that is so, but he did not invite the Members representing Lambeth or Southwark. However, when we met this Secretary of State in January, after the TSA’s final report had been published, the Members for Lambeth and Southwark were included; we were told that this was a south London-wide issue. The reason for the discrepancy is obvious: they knew what they wanted to do. They wanted to get an old plan that NHS London had fostered to try to get Lewisham hospital closed. That took place under a proper clinical review under “A picture of health” four years ago, which concluded that Lewisham hospital deserved to survive and that the services it provided for the people of Lewisham should continue.
	Some 10,000 people marched in November to oppose the proposals. When the final report came out, 25,000 people marched because of the outrageous actions of this administrator and the activities he has undertaken. The manner in which he dealt with the consultations was dismissive, disdainful and high-handed. Whether the objections were from members of the public, GPs or other clinicians, he behaved in line with the instructions from his bosses, which were simply to close Lewisham hospital. The people of Lewisham will not stand for it.

Jeremy Lefroy: I wish to thank my hon. Friend the Member for Bristol North West (Charlotte Leslie) and the Backbench Business Committee for calling this debate. I particularly wish to remember all those in my constituency and elsewhere, and their loved ones, who suffered so grievously. I wish to pay tribute to those here today who campaigned to bring these things to light. I also thank the Prime Minister, the Secretary of State and all other hon. Members for their response to the report a month or so ago.
	One of the main thrusts of the Francis report is to:
	“Ensure openness, transparency and candour throughout the system about matters of concern”.
	This is not the time to debate the Francis report fully—it was commissioned by the Government and it needs full and prompt consideration in Government time—but it is the time to say that the Francis report is of great importance. Mr Francis rightly dismisses the arguments of those who claimed at the time that the inquiry was unnecessary because Stafford hospital was a solitary exception—it was not. It may have been considerably worse than other places, but appalling standards of care have been revealed elsewhere.
	The public inquiry has revealed complacency throughout the NHS and beyond; report after report detailed major concerns, which were either ignored or passed to others to deal with. What lay behind that? Perhaps it was a lack of willingness to shout and continue to shout for help when it was needed; or perhaps it was more often a fear of the consequences—the loss of one’s job or the removal of services from the local community.
	Even just last week, when, as the shadow Secretary of State rightly said, a report to Monitor suggested removing most emergency, acute and maternity services from Stafford—something my constituents and I strongly oppose for reasons I set out in the House last week—there were those blaming Julie Bailey for the proposals. That comes on top of disgraceful threats—even death threats—that she has received over her work in revealing what Robert Francis, who should know if anyone does, calls the “disaster at Stafford Hospital”.
	Let me make it clear that the proposals in the Monitor report are, in the main, a consequence of the financial and clinical pressures that all acute trusts, particularly the smaller ones, are facing. Stafford’s circumstances have done a little to hasten changes, but what happens at Stafford now will face all other such trusts in the coming years. That it is why it is so important that Monitor and the Secretary of State come to a good solution for Stafford, and indeed Cannock, and I will continue to work with them and with my hon. Friends on that. Nobody should take from the Monitor report the message that whistleblowing or more transparency will result in threats to their local services. Indeed, Monitor would be acting contrary to section 62 of the Health and Social Care Act 2012 if it acted in such a manner.
	Let me raise another, perhaps more justified, fear of the unintended consequences of transparency. Only this week, I heard of a case where a patient could have a life-saving operation, but his chances of surviving it are only 50:50, yet without an operation he will die. Some surgeons are, even now, reluctant to take on the operation because if the patient dies, it will be counted against them in their personal mortality statistics. That is an
	unintended consequence of transparency, so transparency has to be balanced with understanding the context; otherwise, we will end up with a risk aversion that is so great that patients will suffer.
	Transparency can also thrive only in a culture that is not led by blame. One of the doctors who gave evidence to Francis said:
	“There was a blame-led culture, the culture being that problems had to be fixed or nursing jobs would be lost.”
	How can we persuade the most suitable people to take up vital, often voluntary, roles on trust boards if their attempts to raise problems are met by blame or indifference? As my hon. Friend the Member for Southport (John Pugh) said, transparency must start right here in Parliament. He spoke movingly about moral purpose, and I agree with what he said.

Therese Coffey: I agree that we do not want to deter people from becoming board members, but surely my hon. Friend must agree that if things are still going wrong and the board is not holding the chief executive and the leadership to account, its members’ positions should be questioned?

Jeremy Lefroy: I would never disagree with that. I entirely agree with what my hon. Friend says, but there is a danger that there will be so much adverse scrutiny that people will be afraid to come forward. We must challenge that and say, “You have every right, as a board member, to raise whatever you want, whenever you want.”
	As I was saying, we need a proper debate here in Parliament on health care in this country, one not constrained by party dogma or blind nostalgia. It is up to us to have that debate and, as a result, give clear direction, rather than simply to react to whatever is thrown at us. We need to debate, for instance, the nonsense of pretending that it is entirely the responsibility of local trusts to deliver. So much is out of their control, be it per-patient funding, which is still far too variable, clinical standards, which are set almost in a vacuum by the royal colleges, or the impact of the European working time directive on costs, rotas and training. We need to debate the impact of the large number of specialisations in the UK—we have 61 as against Norway’s 30—which is driving up costs and driving out vital general medical and surgical expertise. We need to debate emergency and acute tariffs, which have, for many years, meant that hospitals around the country are squeezed and face forced reconfigurations that may not be in the best interests of patients.
	Robert Francis also says that one of the main principles is to:
	“Make all those who provide care for patients—individuals and organisations—properly accountable for what they do and to ensure that the public is protected from those not fit to provide such a service.”
	He also says:
	“There must be a proper degree of accountability for senior managers and leaders.”
	Accountability was sorely lacking at Mid Staffs. There were attempts to see that responsibility stopped with the board. As I have already said, that is based on the fiction that it is somehow entirely in control of its own destiny. It is not. That does not absolve the board or management, but the responsibility is shared by those
	who determine so much of the environment in which they operate, including us here. Professional organisations, for instance, have procedures that make it difficult to dismiss staff who are unsuitable. The Government signed up to the working time directive without preparing for the financial and manpower consequences. And for managers, and indeed politicians, targets became more important than care itself. Again, that is our responsibility.
	I have already said how strongly I oppose the blame culture, and I am not going to start blaming, but accountability involves responsibility, and far too few people have taken sufficient responsibility in this case. We must reflect and they must reflect on the message that that sends.
	Too many inquiries have been left to gather dust on Department shelves, and not just the Department of Health. I and my hon. Friends the Members for Cannock Chase (Mr Burley), for South Staffordshire (Gavin Williamson), Stone (Mr Cash) and Members further afield, all of whom are affected, will not allow this one to gather dust.

Valerie Vaz: It is a pleasure to follow the hon. Member for Stafford (Jeremy Lefroy) and to pay tribute to him for the dignified way in which he has represented his constituency during the Francis report.
	I begin by thanking the Backbench Business Committee for securing this important debate. The NHS in England has a budget of £108 billion and employs 1.35 million people, with just under half of them clinically qualified, so it is right that accountability is at the centre of the NHS, for the people who work there, those who use it and those who fund it. I am sure that all my hon. Friends who have spoken and will be speaking in this debate do not see it as a chance to score political points or as background noise to denigrate an institution that was set up with the simple promise that is delivered every single day—that health care is free to everyone, irrespective of their ability to pay or of pre-existing conditions. It still operates as a service in which people are not judged on their illness but provided with a service.
	I know that the debate is taking place against the background of the Francis report, but I wish to point hon. Members to a book that is about to come out—it is by Roger Taylor and called “God bless the NHS”. It was serialised in The Guardian last weekend. Roger Taylor says in the book:
	“Paul Woodmansey was a senior doctor at Stafford throughout the period that things went wrong; He is mentioned by a number of patients for whom his department provided a haven of professional high quality care while standards in other wards collapsed.”
	Let us not forget then that, even when a light is shone in a corner of the NHS where it is found to have failed the very people it was meant to help, there are areas of good practice.
	Let us look at the background of this debate on accountability.

Jeremy Lefroy: I am sorry to interrupt the hon. Lady, but I would like to point out that the same Dr Woodmansey has been appointed as the new medical director of the Mid Staffs trust Stafford hospital. I welcome that, for the reasons that she has articulated.

Valerie Vaz: Let us look at what is going to happen in 18 days’ time when the Health And Social Care Act 2012 comes into force. I do not want to rerun the arguments about the Act, but let us look at what is to come. Let us look at the accountability of the structures under the Act. The NHS Commissioning Board becomes the conduit for everything, including the flow of money, and all the strategic decisions filter down. If anyone cares to look at the Department of Health website and the new structure, they will see a series of concentric circles. Parliament, the Department and the Secretary of State all appear to be in the outer circle, running round in circles. Where is the accountability in that?
	I have to tell the Secretary of State—although I am pleased to see him here, this is a Back-Bench business debate—that section 75 regulations were signed off, under a negative resolution, by a Minister who is not accountable to the House. Section 75 says that everything has to be tendered except for technical reasons, or reasons of extreme urgency. That had to be changed to state that contracts can be tendered if the relevant body is satisfied that the services to which the contract related are capable of being provided only by that provider.
	Regulation 10 previously said that commissioners may not engage in anti-competitive behaviour; otherwise, Monitor will be after them. Sorry, those are my words. That was changed to say that commissioners must not be anti-competitive unless it is in the interests of patients.
	What of the future? I pay tribute to the right hon. Member for Charnwood (Mr Dorrell), who made an excellent speech. I want to draw attention to a report that our Select Committee produced on complaints and litigation in June 2011. I urge the Secretary of State, if he cares to listen, to read that report and consider all the recommendations. Even then, we called for all providers to have a duty of candour to patients. We also said that we found it striking that the Government did not mention complaints in the information revolution consultation and were surprised that they did not see how complaints information could help people see what is going on. My hon. Friend the Member for West Lancashire (Rosie Cooper), who is no longer in her place, was right to say that complaints can provide information about what needs to be put right.
	Mr Deputy Speaker, I am not sure whether you are aware that the NHS litigation bill has now reached £1.3 billion. I urge the Secretary of State to look into the reasons why that is happening. We have to redress negligence, but there are other reasons why that bill is rising. There are remedies that do not involve money or changes in structures or reorganisations.

John Pugh: Does the hon. Lady acknowledge that that is what the NHS Redress Act 2006 was supposed to do? I am genuinely puzzled, and I hope that the Minister will resolve this puzzle for me, about how much of that Act has been formally enacted.

Valerie Vaz: I cannot answer that; I am not on the Front Bench.
	We all agree that there is no place for gagging clauses if lessons are to be learned about patient care. I agree that the Government have made an important announcement today, but let me remind the Secretary of State that the NHS issued management directions in 1999 and 2004. I am concerned that the NHS still needs
	reminding about these gagging clauses. We must get away from a system in which whistleblowers are driven out of their jobs on spurious disciplinary issues. At Mid Staffs, doctors and nurses are under disciplinary reviews, but as yet I have not heard anything about whether managers will also be held to account.
	Action plans that arise from complaints are a vital part of organisational learning, but they are only of value if they are followed through to implementation, and it was clear from evidence to us in the Select Committee that that did not happen at Mid Staffs.
	Publication of complaints data must be obligatory for all care providers, including foundation trusts and private providers with NHS contracts. We must move away, as the hon. Member for Southport (John Pugh) said, from the blame and victim culture and reduce the emphasis on disciplinary procedures. We must put more emphasis on retraining and risk management.
	We should enshrine accountability for patients at board level, making boards more diverse, not just comprising the usual suspects. Private providers, as my right hon. Friend the Member for Leigh (Andy Burnham) said, are not subject to FOI; they must be. The register of GPs’ interests must be open to clinical commissioning groups. It should not be up to the public to ask whether GPs have declared their interests. Every decision must be associated with a list of GPs’ interests.
	I have spoken to the chief executive of the Royal Orthopaedic hospital, who said that he ensures that doctors, nurses and managers are all on an equal footing, which is an example of good practice. His phrase is that there should be “no gap between board and ward”. He puts his patient groups on the board, every ward gets rolling visits and board members even feed the patients.
	In my own way, I have also been accountable and I have published on my website a table of all the complaints my constituents have come to me about so that they can see what sort of things are going on at the Manor hospital. The chief executive of the hospital is undertaking a patient survey and ensures that he looks at all the responses.
	I hope that I have outlined some positive aspects as a way of moving forward and that we will continue to have an accountable, transparent and unique NHS that is the best in the world.

William Cash: I believe strongly that we must not only look back properly at what happened at Stafford hospital but look forward. We must learn the lessons and we must ensure that what happens in future does not lead to the trauma experienced by the victims and patients in my constituency and those of my hon. Friends the Members for Stafford (Jeremy Lefroy) and for Cannock Chase (Mr Burley).
	This is a debate about accountability and transparency and, as others have said, we also need a debate in Government time on the Floor of the House on the Francis report. On the question of accountability and transparency, I want to start with an issue that has not yet been properly considered in the debate: the role of the Secretary of State under national health legislation. Section 1 of such legislation clearly states the duties
	of the Secretary of State, and always has done. I was astonished, as I made clear at the time, when the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) left out that part of the question of accountability.
	I have been involved in the history of this case. As the Member of Parliament for Stafford from 1984 to 1997 and the Member of Parliament for Stone from 1997 to the present day, I have had many constituents, including Debra Hazeldine, a prominent member of Cure the NHS, who have played an important role in drawing attention to these matters. I have worked closely with them over the whole of this period.
	Contrary to what the right hon. Member for Kingston upon Hull West and Hessle said—I imagine must have been a serious slip of memory—I wrote letters to him. Ministerial guidelines from 2005, issued by the Cabinet Office, set out in great deal what must happen when a Member of Parliament writes to a Secretary of State. He must receive a personal reply. I do not need to go into the full details now, but only the other day I asked the Minister for the Cabinet Office and Paymaster General to reaffirm the contents of those guidelines, which are still applicable.
	There are only 650 of us, and serious matters can arise from the complaints we make. I am talking not about the complaints procedure of the national health service but about a Member of Parliament going to the Secretary of State to raise a specific question, usually enclosing correspondence from a constituent, and asking for action. In my case, I said that the matters I raised were both serious and urgent and that they required the personal attention of the Secretary of State. I have not the time to go into the detail, but successive Secretaries of State simply did not take the kind of action that I would have expected following those letters.

Alan Johnson: This is a fascinating subject and I am willing to have a look at any correspondence between the hon. Gentleman and me when I was Health Secretary. I certainly tried very hard to correspond with all Members of Parliament. Does he accept what Francis said:
	“Local MPs received feedback and concerns about the Trust. However, these were largely just passed on to others without follow up or analysis of their cumulative implications…They might wish to consider how to increase their sensitivity with regard to the detection of local problems in healthcare”?
	We all have lessons to learn from the Francis report; does he accept that he has lessons to learn, too?

William Cash: We all have lessons to learn about all matters relating to these questions, but the guidelines also talk about the necessity of chasing and following up in the Department. It is probably a question of the correspondence unit in the Department and the private office. There was a failure and the Francis report made it absolutely clear that the guidelines were not complied with and were not operated effectively. I am sure that the right hon. Gentleman, on reflection, will recall that that was what the report said.
	I referred to these matters in my witness statement, and Una O’Brien, the permanent secretary at the Department of Health, also made it clear in her evidence that if such letters were received now, they would receive an immediate response, irrespective of whether the hospital was a foundation trust or not. The bottom line is that
	there was a failure within the Department and by successive Secretaries of State. The shadow Secretary of State acknowledged in his evidence that he looked at these letters. I will not dispute that. However, not only were the matters not dealt with satisfactorily, but I cannot absolve the Secretaries of State from their failure to agree to the 2005 Act inquiry.
	I do not need to rehearse the history of the case. I asked not once, not twice, but repeatedly, and I had to urge and persuade the shadow Secretary of State at the time and also—I am glad that, to his great credit, he decided to do so—the present Prime Minister who, as Leader of the Opposition, decided in the light of my representations and no doubt those of others to have the 2005 Act inquiry. Without that we would not be discussing the Francis inquiry—the present one, not the previous one, important though that was—and the others. They were Government inquiries, but they did not do the job in the way the present inquiry did.

Andy Burnham: I am listening carefully to what the hon. Gentleman is saying. It is not strictly true to say that that was a Government inquiry. I brought in Robert Francis—will he acknowledge that?—in July 2009 to conduct an independent inquiry. As my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) said, in presenting his findings Robert Francis said that he felt that more people had come forward because of the nature of that inquiry.

William Cash: I will let the matter rest at that point for the present purpose.
	I move on to the next question of accountability, with respect to Sir David Nicholson. I referred to Sir David in a number of debates way back as far as 2009. I also referred to him in my evidence to the Health Committee, in my witness statement and in correspondence with the Francis inquiry. In my judgment, for the reasons that I have already given, there was a systems failure with respect to this whole terrible tragedy, not only in relation to Mid Staffordshire, but more generally.
	We need to turn a new page. I am not saying that Sir David should receive a P45 now. What I am saying is that, sooner rather than later, it is essential that he departs his post. I disagree with the Secretary of State and therefore also, I admit, with the Prime Minister on this matter, and so do many others. Accountability must mean what it says, and in this context it means carrying the can. The whole saga took place on Sir David’s watch, even though he was not at West Midlands for more than a certain time, and the problems that have arisen carry with them issues of accountability.
	I acknowledge that Robert Francis referred to scapegoats. It is not, as has been said before and I repeat, a question of blaming scapegoats. It is a question of responsibility and where it lies at the time. In my judgment it did not lie only with the Secretaries of State of the time. In fairness, they have apologised.
	I conclude with a statement made by David Nicholson at a conference that took place a few months ago. He made it clear in that statement that he took personal responsibility for what had happened. It is very important that we recognise that he has apologised and that he has made a statement that is clearly an admission that he
	lost the plot when, as he put it, ward 10 in Mid Staffs was under severe stress. That is the problem and I believe he has to go.

Ann Clwyd: I congratulate the hon. Member for Bristol North West (Charlotte Leslie) on securing this debate. It is with great regret that I continue to speak about issues of abuse and neglect in our national health service. As of now, I have personally received more than 2,000 e-mails and letters. The letters continue to come every day; I want to mention just a few. All who have sent them want their stories to be heard.
	The first letter says:
	“My mother died in August this year”—
	that is, last year.
	“I still feel so angry about her treatment. She caught a hospital-acquired infection that certainly contributed to her untimely death. The lack of care and compassion that I saw horrified me. Oh yes, the boxes were all ticked. Water jug, food, medication. And all left out of reach. A nappy put on her because they couldn’t be bothered to answer her calls for assistance to the toilet. A proud and dignified mother left to sit in her own vomit. I haven’t put my complaints in writing to the hospital, as it’s not going to change anything. But maybe writing to you will help. I need my voice to be heard.”
	The second letter says:
	“Our Dad died in January last year. His death was quite unexpected by us as he was an active, cheerful pensioner, who went into hospital in October 2012 to have a knee operation. Unfortunately, whilst in there, his condition deteriorated, he also acquired hospital-acquired pneumonia and died. Throughout his stay in hospital his family visited him regularly and our experiences were very similar to yours. We found it very difficult to find any staff to talk to or to help him and our Dad told us about all kinds of mistreatment, neglect and mistakes that he was having to endure. Unfortunately, although normally a strong character, he also became afraid of some of the staff, who appeared to be bullying him, but he was absolutely adamant that he did not want us to mention any of his mistreatment to anyone as he was convinced that, once we left, these staff would then treat him even more badly. So we found ourselves in an impossible position, watching our Dad deteriorate before us—he had stopped eating—and hearing shocking accounts of his ‘care’ where he refused to give us any names, and yet feeling quite powerless and unable to speak to anyone about this.
	Of course, at this stage, we did not know that he was going to die and we were just counting the days till we could get him out of there, but that never happened in the end.”
	I have a third case:
	“My memories of my father’s treatment in hospital are still so raw. He, like so many others who have suffered under the ‘care’ of NHS staff, was a man who had shown such bravery in the war (he was a veterinary officer in the Chindits in Burma, behind the Japanese lines) and in his life after, he was a true gentleman and would do anything for others, and he would not complain. He had faced death many times and through his bravery had survived against all odds, but in the end his death was to be hastened because of hospital-acquired infections, and from care bordering on neglect. Tragically he died sad and utterly disillusioned. He simply could not believe that medical staff, including consultants, could treat him and others as they did. He had placed utmost trust in them, and most of them could not care less. He looked at me one day, with utter anguish and despair in his face, and in great pain, and said, ‘Oh Annie, I would never have treated any of my animals in this way.’”
	The next letter says:
	“My husband of 84 underwent extensive tests to determine the reason for his illness, which didn’t manifest itself until the pancreatic cancer which had remained undiagnosed spread to his bladder. During all this time my main concern was the lack of nursing care.
	He had been shunted into a side room on his own for being ‘difficult’ and as far as I could see was simply ignored. On one visit I found him lying in his own excrement while the staff were gathered gossiping round the nurses’ station. All my requests to see a doctor were fobbed off, until one doctor mentioned casually in passing that a lump had been found on my husband’s bladder. No attempt was ever made to discuss his diagnosis with me.”
	I have some shorter examples:
	“I went to the nursing station on one occasion to see the entire Team bidding at the end of an eBay auction. I was kept waiting, ignored, until it was ended!”;
	“first time in hospital mother had 2 broken wrists. No one would feed her when meals were delivered, despite the fact that she had 2 arms strapped up in the air! My aunt had to travel over 2 hours by bus every day just to ensure she was fed”;
	“When visiting my wife… after an operation to mend her broken hip, I asked a nurse for help as she was being very, very sick. She announced ‘I am a graduate, I don’t do sick’, and left me to deal with the situation”.
	As I said, I have received many letters. I have tried to acknowledge each one and respond, although obviously I cannot do so in detail. They keep coming. It is not something that pertains only in England; the same is true in Scotland, Wales and Northern Ireland. I have received similar letters for all parts of the United Kingdom.

Aidan Burley: May I thank the right hon. Member for Cynon Valley (Ann Clwyd) and say how sobering it was to listen to those stories? I join my hon. Friend the Member for Stafford (Jeremy Lefroy) in paying tribute to the families and loved ones of patients from Stafford and Cannock who had such appalling care and praise them for their strength in telling their stories. My hon. Friend and I will fight against any serious downgrading of Stafford hospital and, more importantly, from my perspective, any possible closure of Cannock hospital, which is managed by the same trust. I note that the Staffordshire Newsletter today launched its “Support Stafford Hospital” campaign, which I am sure we will both be supporting.
	Today’s motion calls for accountability and transparency in the NHS. In relation to Mid Staffordshire NHS Foundation Trust, there are three areas that most need accountability and transparency: the granting of foundation trust status in 2009; the opposition to the public inquiry into what went on; and the “targets at all costs” culture. I will deal with each in turn.
	We have the indignity and embarrassment of Mid Staffordshire NHS Foundation Trust being abolished by Monitor only five years after being granted that status. I want Members to think about that for a second. Only five years ago it was considered so outstanding and such an exemplar of compassionate care and sound finances that the right hon. Member for Leigh (Andy Burnham) awarded it foundation trust status on 1 February 2008.

Andy Burnham: May I just correct the hon. Gentleman? I was not a Minister in the Department of Health on 1 February 2008. Furthermore, the awarding of foundation trust status was the responsibility of Monitor, not Ministers in the Department.

Aidan Burley: I believe that the right hon. Gentleman’s second point is incorrect; as I understand it, the Secretary of State—I accept that that was the right hon. Member
	for Kingston upon Hull West and Hessle (Alan Johnson)—signs off on the awarding of foundation trust status. We know that he admitted to the public inquiry that he looked at just four lines of civil service evidence about foundation trust status before signing it off. Is that good enough for a Secretary of State? Why did he not look at it in more detail? Was he not really bothered? I think that was a dereliction of his duty to ensure public health in Staffordshire and that he should have the decency to apologise to the people in the Public Gallery who have come here today from my constituency and that of my hon. Friend the Member for Stafford.
	Alternatively, was the foundation trust status signed off because of the culture of targets at any cost under the previous Government? Was organisational form, whatever it means, more important than patient care? We know locally that they wanted to prove that their foundation trust policy was a success, and that took priority over what it really meant for patients and their care. Members do not have to listen only to me on that point. Here is what a Mid Staffordshire NHS Foundation Trust non-executive said just this week in a public meeting in Rugeley in my constituency:
	“Our problems started when they made 200 nurses redundant in 2008 to achieve an acceptable financial footing for Foundation status, but care standards slipped thereafter and by 2009 they had a £2m deficit.”
	Everyone knows that huge pressure was put on David Nicholson by his political masters to have a foundation trust in the west midlands, and poor little Mid Staffordshire was the one that was forced through. In the interests of the accountability and transparency that the motion calls for, I want to hear an apology from those who forced through foundation trust status at a time when people were dying from appalling care and the trust was going bankrupt.
	This is not just about politicians. If anybody is in any doubt about how ingrained the targets culture had become, let me quote from an old press release from Mid Staffordshire trust that I found, dated 3 October 2002. It has been taken off its website but is still findable if one looks around on the internet. It says, under the heading, “Babies’ Service of Remembrance”:
	“A short service of Remembrance for those whose babies have died in the past few years is being held in the Pilgrim Chapel at Stafford General Hospital.”
	Just seven days later, under the heading, “Good News from Mid Staffordshire General Hospitals NHS Trust”, it said that David O’Neill, the chief executive, was
	“delighted to announce that the Trust has been short-listed to the last three for the National Partnership Industry Award for our Bed Management System”.
	This culture is absolutely astonishing, and it simply has to change.
	We have now had the public inquiry and Robert Francis has laid out in full gory detail the horrendous failings at Stafford hospital. One might have thought, given what went wrong, that there would have been cross-party support for a public inquiry, but not so. I presume that Labour Members now support the findings of the Francis inquiry. There were certainly many Labour MPs at the all-party health group meeting with Robert Francis on Tuesday, but I want to know how many of them were among the 260 Labour MPs who voted against a Commons motion calling for a public inquiry on 18 May 2009. [Interruption.] These might be
	uncomfortable facts for the right hon. Member for Kingston upon Hull West and Hessle, but let me point out that Labour Members ignored 81 requests for a full public inquiry into Mid Staffs between January 2009 and May 2010. They received 20 letters from MPs, 36 letters from members of the public and 25 letters from organisations. They ignored the families who protested outside the Department of Health for a public inquiry, including people from Cure the NHS.
	The right hon. Member for Leigh, as he has said today, rejected a full public inquiry on the grounds that it would “distract the management”. He is welcome to intervene to tell me whether he now accepts that that judgment was wrong.

Andy Burnham: Will the hon. Gentleman acknowledge that I asked Robert Francis to conduct two independent inquiries into what happened? It is not the case that I was not doing anything. I made that judgment because I wanted to get to the truth of what happened while not overburdening the hospital with the job of getting better. I tried to strike that balance, and that is why I reached the judgment that I did.

Aidan Burley: I will accept, as will, I think, everyone in this House, that the right hon. Gentleman has refused to answer the question again. He will not say whether that judgment was a mistake, and until he does so we cannot take what he says seriously.
	The then Health Secretary, the right hon. Member for Kingston upon Hull West and Hessle, joined in the refusal to have a full public inquiry. He said to The Birmingham Post on 19 March 2009,
	“I really don’t think with the greatest respect that a public inquiry is going to take us any further forward”.
	Will he intervene to tell me whether he will be writing to The Birmingham Post to tell people whether it has taken us any further forward? He can scowl across the Chamber, but I am afraid that that is no answer.
	In the interests of accountability and transparency, we need to know why the Labour Government opposed a full public inquiry into Mid Staffordshire. Why were they so afraid of finding out the truth of what went on? Is it really so important to protect the reputation of the NHS as an institution rather than to protect the patients whom it serves and who ultimately pay for it?
	There are now abounding claims and counter-claims about Stafford and Cannock hospitals as a result of the indignity of having our foundation trust abolished. One would have thought that having forced through foundation trust status and opposed a public inquiry, Labour locally would have some contrition, but sadly not. The Labour leader of my local council and Labour’s prospective parliamentary candidate for Cannock Chase are now teaming up to
	“fight plans they feel are aimed at privatising Cannock hospital.”
	The leader of the council said that he was launching a petition against being
	“victims of Tory privatisation plans”.
	There are no plans in the Monitor report to privatise Cannock hospital, so I want to know where the local Labour party is getting its information from. In fact, as a result of the FT status, private providers are already operating in Cannock hospital. I note that there were no protests from Labour councillors when private health
	facilities were introduced into Cannock hospital. Again in the interests of accountability and transparency in the NHS, I call on Labour Front Benchers to stop their parliamentary candidates and council leaders scaremongering among local people for political ends. They cannot fight privatisation if there are no plans to privatise anything. They cannot start a petition to save Cannock Chase hospital if the Monitor report suggests making it a centre of excellence for orthopaedic elective surgery in the west midlands. They cannot oppose a public inquiry and then welcome all of its findings. They cannot force through foundation trust status for its own sake rather than for what it will achieve for patients; and if someone does force it through and it has the reverse, perverse effect of causing appalling care, unnecessary deaths and the bankrupting of the trust and its abolishment just five years later, they should be man enough to apologise.
	I agree that we need to be more accountable and transparent. That starts from the top with Secretaries of State and goes down to the bottom to the local council leaders and their parliamentary candidates.

Barbara Keeley: I was appalled to read in the Francis report on the Mid Staffs inquiry the stories of the unnecessary suffering of hundreds of people and, indeed, to hear the examples given by my right hon. Friend the Member for Cynon Valley (Ann Clwyd) in this debate. Those Mid Staffs patients were let down and there was a lack of care, compassion, humanity and leadership. The most basic standards of care were not observed and fundamental rights to dignity were not respected.
	Our Health Committee has taken evidence from Robert Francis, who has said that there was a failure of the NHS system
	“at every level to detect and take the action patients and the public were entitled to expect.”
	He has summarised his own recommendations as: fundamental and easily understood standards; openness, transparency and candour; accountability to patients and the public; enhanced training for nurses and leaders; and ever-improving measures of performance.
	In the short time available, I want to focus on two areas: first, accountability or, indeed, the lack of it in our NHS structures, and secondly—this has already been touched on—the question of what is good practice on patient safety.
	The Health Committee is increasingly seeing examples of a gap in accountability in the restructured NHS and I will touch on one small example that we heard this week. We had a session with senior Department of Health staff—the director of mental health, the national clinical director of mental health and the deputy director of secure mental health services—who are responsible for advising Ministers on mental health strategy, for devising mental health legislation and for clinical leadership on mental health. They did not know that patient groups were reporting cuts to community mental health services or that they lacked access to therapeutic services, with very long waits.

Alison McGovern: Does my hon. Friend agree that scrutiny to make sure that the dignity of mental health patients is protected is of utmost importance?

Barbara Keeley: Indeed. It is disturbing that the people responsible for advising Ministers on legislation are not aware of what is going on. In fact, they started by trying to tell me that they thought that community services were still expanding, as they had been up to 2010. They did not have a picture of the services. Indeed, they told us that there was no routine collection of waiting times for mental health services and they did not have data on readmissions. They did not even seem to understand the trends involved in those important issues.
	The exchange left me feeling very concerned about accountability in our new NHS structures. If staff at the most senior levels of the Department of Health who are responsible for strategy and legislation have no idea what is going on in health services across the country, that is serious. The major restructuring of the NHS seems to us—this has been mentioned by fellow members of the Health Committee—to represent a decline in accountability.
	We need to learn from good practice to improve patient safety, which has been touched on by my hon. Friends the Members for West Lancashire (Rosie Cooper) and for Walsall South (Valerie Vaz). A major review is taking place of the 14 hospitals with the worst mortality rates. In recent Health questions, I told the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) that good practice in hospitals with low mortality rates should be investigated alongside the review of high mortality rates and poor practice in the worst-performing 14 hospitals. He did not take that point on board, so I will try again today.
	I want to talk about what has been achieved at my constituency’s local hospital trust, Salford Royal NHS Foundation Trust. I visited the hospital recently in the wake of the Francis report and was impressed to hear what it has achieved over the past five or six years. It already seemed to have in place many of Robert Francis’s recommended actions, which I touched on earlier. Salford Royal has taken action on nurse staffing ratios, which my right hon. Friend the Member for Leigh (Andy Burnham) touched on; reducing MRSA infection and pressure sores; the transparency of patient information; and involving clinical staff in quality improvement.

Jeremy Hunt: I completely agree with the approach that the hon. Lady is taking. One of the jobs of the new chief inspector of hospitals will be to identify the outstanding hospitals, the safest hospitals and the hospitals with the best compassionate care, so that other hospitals can learn to do the same things.

Barbara Keeley: That is very good. I hope that the Secretary of State will make that point to the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich, because he did not seem to appreciate it when I made it to him in Health questions.
	Let me touch on what other hospitals might find if they start looking at the excellent practices at Salford Royal. I do not underestimate the importance of the terrible examples that we have heard about, but at the same time, my trust has had a quality improvement strategy since 2008, with specific projects that are aimed at reducing falls, unexpected cardiac arrests, surgical
	site infections, sepsis and other harms. Because harm tends to be caused to patients much more over the weekend—we have seen many examples of that in the cases that we have looked at—the trust has moved back to seven-day working in an attempt to achieve the same standard of care on the weekend and overnight as people receive on a weekday during working hours.
	I believe that having the right nurse staffing ratios is vital to patient safety, but that issue keeps being glossed over by NHS leaders and Ministers. I have asked questions about it repeatedly in this House. Salford Royal uses a safe staffing tool to ensure that it works to safe staffing levels. There are minimum staffing requirements throughout the hospital and incident reports are completed if the ratios are not met. Each division reviews its staffing establishment every day and escalates concerns if the numbers fall below the minimum safe level. Salford Royal is a mentor site for nurse rounding which, as we have heard, means that nurses go round their patients each hour to ensure that their needs are being met.
	My right hon. Friend the Member for Cynon Valley gave examples that showed the impact of hospital-acquired infections. All the work that is done to reduce MRSA and other infections is crucial. As in the other examples of flattened hierarchies that we have heard about, anyone at Salford Royal can challenge others on issues related to infection control. There is also mandatory training in aseptic non-touch techniques.
	Teams design their own quality improvement projects in a clinical quality academy. There has been a specific quality improvement project over the past 2 years that is aimed at reducing the number of pressure ulcers. Each pressure ulcer is declared, the root causes are analysed and the patients are involved in the investigations. Nurses can monitor the positioning of patients on their hourly rounds and help to turn them if required. Those examples of good patient care can help us to get over the kinds of awful care that have been described today.
	My final point is about transparency. Patients and families can check the harm data, because they are shown on a whiteboard at the entrance to every ward. The board records not only how many days it is since the last MRSA infection or pressure ulcer, but provides assessment scores on 13 fundamental nursing standards. Such public reporting to patients and families is important because it aids accountability and helps staff to feel accountable for the standards on their ward. We need that now more than ever.
	Unsurprisingly, Salford Royal has achieved the highest rating in the NHS staff satisfaction survey for acute trusts in the NHS. Staff are supported to challenge existing systems and test new ideas to improve standards. I am aware of how much of a contrast that is to what we have heard this afternoon. The NHS is a system in which one area has had a catastrophic failure at all levels of patient safety, while other areas have achieved the highest standards of safety and patient care. We must look at both if we want to understand why that is.

Sarah Wollaston: I want to start by thanking the vast majority of staff in the NHS, who go to work every day motivated to serve their patients and deliver world-class care.
	We should not think that we can just return to the halcyon, storm-free days of the 1970s, when NHS care was perfect. Before I started medical school, I worked as a nursing auxiliary, which would now be called a health care assistant, in what was then known as a geriatric hospital. I have no wish to return to the days of vast, mixed wards and a rather authoritarian approach to care. I would far rather the NHS of today than that of the 1970s.
	However, the mantra that the NHS is the envy of the world sometimes gets in the way of providing decent feedback and criticism when things go wrong—and after listening to the words of the right hon. Member for Cynon Valley (Ann Clwyd), who could say that things do not go wrong? The failures at Mid Staffs, and the fact that more than 1,000 people died in a single hospital, are truly shocking. Robert Francis told the Health Committee that he had spent three years of his life “listening in horror”—how shocking! It is hard to imagine any other institution or organisation where death on that scale would not have led to prosecutions, yet too often in the NHS it is not prosecutions that follow but promotions, just as it was in this case.
	It has, unfortunately, become something of a heresy to criticise the NHS, and my comments are not to be interpreted as criticising the vast majority of staff, but rather as a means of considering how we can help those staff and their patients. It is vital that NHS staff are free and feel safe to raise concerns. This week, at a meeting in the House that I was chairing, Robert Francis spoke about “complaints being a gift”, but that is not the experience of staff or patients within the NHS.
	The Health Committee conducted an inquiry into complaints and litigation in the NHS that reported in June 2011, and I wish to read from the chilling evidence that we heard from Nicola Monte. She spoke of her experience of being barrier-nursed in Stafford, and said that a nurse came into her room and berated her saying, “I have been off sick because of you complaining about me. Do you realise the suffering you have caused me?” Too often, staff end up feeling that they are victims because—as they know—they are often scapegoated for what are system failures, often by management. That runs throughout the NHS; the response to complaints is defensive and dismissive and that must change if we are to implement what Robert Francis rightly recommends as a new culture change of openness, transparency and candour within the NHS.
	I hope, however, that no one will think that introducing a statutory duty of candour can be a single approach. That will not work without a culture change that supports and welcomes complaints as a “gift” to identify problems and improve care. I hope the Government will implement in full the recommendations made by Robert Francis so that complainants are regarded not as the problem but as part of the solution.
	I particularly welcome the Secretary of State’s announcement that gagging clauses are to be outlawed with immediate effect throughout the NHS but—I hope he will not mind me saying this—that must extend to the top of the system. Would the Secretary of State feel it appropriate for David Nicholson’s secretary to have the following clause in his or her contract:
	“That they should avoid associating themselves with recommendations critical or embarrassing to the NHS commissioning board.”?
	I think we would find that wholly unacceptable, yet, if I may refer Members to the ministerial code of conduct, the Secretary of State’s Parliamentary Private Secretary, who is not a member of the Government, has exactly that clause within his contract. That is something we have to change because the culture of the NHS must extend from the Department of Health to the nursing auxiliary—or health care assistant—at the bedside, and to patients so that they and those around them feel safe and able to raise complaints.

William Cash: Is my hon. Friend aware that Public Concern at Work, to which I referred in my witness statement on Stafford hospital, has played a big role in highlighting whistleblowing and has set up a commission to look at that issue? The outlawing of gagging clauses should apply not only on severance, but also—emphatically—when people are in post so that they can be properly protected when acting in the public interest.

Sarah Wollaston: I absolutely agree. This is about starting to identify the culture and values of the people we employ in the NHS, and making it clear that not only does everyone in the NHS have a duty to bring forward concerns, but that those concerns will be welcomed and acted on. I would like everyone in the NHS to have an individual to whom they can go and feel safe in raising their concerns. I thank my hon. Friend for raising that point.
	My hon. Friend the Member for Reading East (Mr Wilson) has told me that he does not feel that he has been gagged, which is great, but there is still an important point of principle: as a PPS, he is not able to speak in this debate. We want everyone, from the very top of the NHS and the Department of Health, right through to the bottom of the system, to feel that they are fully free to raise any concerns they have, wherever they may be.
	After the Bristol heart scandal, whistleblower Stephen Bolsin was asked how we could prevent this from ever happening again. He said:
	“Never lose sight of the patient.”
	His whistleblowing cost him his career. He first raised the alarm in 1989. His work over six years to raise his concerns remains one of the single most important improvement in clinical outcomes in the NHS—that is how important whistleblowers are to our system. Yet the scandals keep happening. Would it not be a tragedy if, five years from now, we were still saying, “We need to put patients at the heart of everything we do in the NHS”? It is time to make that happen.

Frank Dobson: I congratulate the hon. Member for Stafford (Jeremy Lefroy) on his thoughtful contribution to the debate. We all owe it to the people of Stafford and those round about, all of whom depend on Mid Staffs, to ask the Secretary of State to guarantee that nothing and no one is allowed to use the horrors that occurred as an excuse to close the hospital or to run it down. That would punish the local people, the potential patients, and the good staff at the hospital. I hope he is willing to make whatever organisational changes—extra cash, or new ways of financing parts of the health service—are necessary to make that guarantee to the people in that area.
	I started off has Health Secretary fully in favour of transparency. My last job before I became an MP was working for the local government ombudsman. It was my view, and it remains my view, that the best way to deal with anything that has gone wrong is to stand up and say, “Sorry, I got it wrong.” However, there is a problem. We are asking people in the NHS to operate in two different worlds. If something goes wrong in the hospital, the GP’s surgery or the clinic, we say: confess straight away. That is one world—the official world. People then get in their car, drive out of the car park to go home and bump into another car. What happens? Their insurer says, “Whatever you do, don’t accept any responsibility.” We need to recognise the clash of different worlds that people live in.
	When the excellent hon. Member for Aldridge-Brownhills (Sir Richard Shepherd) introduced the Public Interest Disclosure Act 1998 to protect whistleblowers, I made sure that the Labour Government supported it, and that the provisions covered the national health service. There were those who did not want it to cover the NHS. I am delighted to say that I anticipated that some might want to have disappearance clauses in contracts—gagging clauses—and issued a circular that prohibited them. Any health body that has inserted such a clause is breaking the terms of the circular that was sent out in my name in 1999.
	I also established the Commission for Health Improvement. It was intended to monitor and improve standards, and it was the first time in the history of the national health service that such a body had been set up. At that time, there was no machinery in the NHS for identifying good or bad practice, or for promoting good practice more widely and eliminating poor practice. I also required all health boards and chief executives to be responsible for the quality of treatment and care. No such obligation had been placed on them before, and that was a step in the right direction.
	The hon. Member for Stafford rightly said that if transparency is to be based on experience and on data, those data have to be fair. We cannot have a situation in which someone who performs regular, straightforward surgery is compared favourably with someone who treats people in desperate circumstances and therefore has a greater chance of the operation or treatment going wrong. Everyone in the medical profession has got something wrong, and some have done so quite a few times.
	If we are to have transparency in the provision of services to NHS patients that are paid for by public money, that transparency must apply not only to the NHS providers but to any other franchised provider of services. I know from experience that, when our lot were selling off a GP practice in my constituency, we were told that we could not find out the terms of the contract because it was commercially confidential. If we had been able to see the contract, we might have spotted that it enabled the contractor to leg it if things got difficult, which is what it duly did.
	However keen Government Members might be on involving the private sector—I freely admit that I am not, but they are—they must ensure that patients and others are not denied information on the ground of commercial confidentiality. I strongly support the idea of making whistleblowing a duty, and that duty of candour
	must apply to any private sector provider. We cannot have them hiding away behind their private profit-making efforts. We must also ensure that, when anything goes wrong, the Secretary of State will answer to the House of Commons. We do not want anyone coming along and saying, “It wasn’t me, guv, it was the commissioning board wot got it wrong.” We must make it absolutely certain that our national health service is responsible to us here.
	My final point is that I am sick to death of what is happening at the Whittington hospital. In order to qualify for trust status, it is being told to reduce the ratio of nurses to patients, yet it is already one of the five safest hospitals in the country.

Stephen Barclay: I join other Members in welcoming the Government’s announcement today of a ban on gagging clauses, but is it not surprising that we need such an announcement? The right hon. Member for Holborn and St Pancras (Frank Dobson) has just told the House that he issued guidance on this issue in 1999, and we also have the Public Interest Disclosure Act 1998 and the 2004 guidance. My right hon. Friend the Member for South Cambridgeshire (Mr Lansley) even put these conditions in the NHS constitution, and yet we find that we need an announcement on the matter today. My hon. Friend the Member for Stone (Mr Cash) has been repeatedly assured that there is no problem. I raised the issue in some detail with Sir David Nicholson in the Public Accounts Committee on a number of occasions, and I was constantly told that there was no need for change, so does Sir David agree with today’s announcement? Indeed, is a change being announced? Will the Secretary of State confirm that this announcement covers all payments, including those through judicial mediation, and will it apply retrospectively?
	There seems to be a striking uniformity as between both Front-Bench teams when it comes to telling us that Sir David Nicholson is a wonderful manager, yet he did not know about the high mortality figures—even though they have been published in national newspapers since 2001; even though his own staff were logging in to the Dr Foster data; and even though the figures were high when he was the chief executive of the strategic health authority that was responsible for Mid Staffordshire. He did not know about gagging clauses when he was the accounting officer; he did not know about fixing mortality codes, yet they are now subject to police investigation. As he told the Health Select Committee, he did not know about judicial mediation—a flaw in the system, yet he is responsible for system and controls. He did not know about the Gary Walker case.
	My hon. Friend the Member for Bristol North West (Charlotte Leslie) says that she has concerns about the US reports, but once again, Sir David seems not to know about them. He did not know about the Royal College of Surgeons 2007 report into Mid Staffs, which raised serious concerns, as my hon. Friend the Member for Stone is well aware, but in respect of which no action was taken. In other areas, too, we should remember that he was not just the accounting officer for the wonderfully successful NHS IT programme, but the senior responsible owner. We are told that he is a great manager, but it is difficult to see the evidence to sustain that claim.

William Cash: In a conference on 4 October 2012, I understand that Sir David Nicholson said that
	“the senior leadership of the NHS and I was part of it in those circumstances”
	but “lost the plot”. He continued:
	“We lost the reason why we were there. We got so excited about…changes”,
	but he went on to acknowledge that
	“on ward 10 in Mid Staffordshire Hospital really bad things were happening”.
	That is the sort of admission that he had to make in those circumstances. Does my hon. Friend agree that that amounts to admitting responsibility for the system’s failure?

Stephen Barclay: I do agree with my hon. Friend, and that does seem at odds with the Government’s welcome commitment to promoting individual accountability. In response to the Robert Francis report, the Prime Minister talked about three fundamental problems with the culture of the NHS. Of course that went beyond one individual.
	I am concerned about the timing of the announcement of the appointment of Barbara Hakin, a close ally of Sir David Nicholson. It is important to note that she is innocent of any allegations being made against her, but I understand that she is under investigation at the moment. The timing of the appointment, then, seems strange. I invite my right hon. Friend the Secretary of State to intervene to clarify whether he was told of Barbara Hakin’s appointment prior to it being made. If he was not told, does not that say something about the power that Sir David wields within Richmond House?.
	A further issue is whether Parliament knows the quantum or scale of the payments made to whistleblowers. I have repeatedly raised this matter over the last two years and was finally given a figure of £15 million paid over three years—silencing quite a lot of people. It now emerges, however, that that is not the whole story, as it does not cover payments such as the one for Gary Walker, which was paid through judicial mediation.
	As seen in the NHS manual for accounts, each NHS body or trust is required to compile a register detailing all special payments made, including those through mediation. As I understand it, even the Department of Health does not know how many such payments have been made—and that applies to the Treasury, too. In a response to my parliamentary question this Tuesday, the Minister said:
	“Approval has not hitherto been required by the Chancellor or the Secretary of State for Health for special severance payments made as a result of judicial mediation. However, as of 11 March”—
	this Monday—
	“approval will be required.”—[Official Report, 12 March 2013; Vol. 560, c. 182W.]
	The position seems to be moving as of this week. Parliament does not know how much has been paid to whistleblowers, so will the Minister clarify when we will know?
	In my Adjournment debate of a week last Monday, my hon. Friend the Member for Bracknell (Dr Lee) asked whether the chief executive of Mid Staffs was subject to a gagging clause. We received a welcome reassurance that we would be given an answer, but when we were on our way to the Chamber for this debate, my
	hon. Friend told me that he had received none. I hope that the Minister will clarify whether Mr Yeates was subject to a gagging clause.

Aidan Burley: Is my hon. Friend aware that Mr Yeates left in 2009 with an £80,000 pay-off and a six-figure pension lump sum before moving to a job with a charity called IMPACT Alcohol and Addition Services, based in Shropshire, and that he refused to give oral evidence to the inquiry because of a unique form of post-traumatic stress disorder? Where is his accountability?

Stephen Barclay: My hon. Friend is right. Not only did Mr Yeates leave with, I understand, a significant payout, but he went to work for a charity that was in receipt of Department of Health funds. I think that as a matter of urgency we should clarify the terms on which Mr Yeates left the NHS, what Ministers knew, and what senior officials—in particular, David Flory—were aware of at the time of his departure.
	I fear that we are in danger of sending a confused message to staff and families of patients in the NHS. On the one hand we say that the culture needs to change, but on the other we say that the people who are responsible for that culture—the people who are paid significant sums to lead it—should stay.
	My hon. Friend the Member for Totnes (Dr Wollaston) is absolutely right: there is much in our NHS that we should celebrate and of which we should be proud. However, we do it a disservice if we are not prepared to identify where it is going wrong, and to be transparent about the areas with high mortality and about the existing culture which has a chilling effect on those who are brave enough to speak out. Is it not informative that the one person who spoke out at the Bristol inquiry, and who did so much good, is the one person who has never worked in the NHS again?
	I think that the challenge for the House today, and in subsequent weeks, is to ensure that this time it learns the lessons that were clearly not learnt then.

Virendra Sharma: Thank you, Mr. Speaker, for allowing me to speak in this important debate. I congratulate all those who made it possible.
	In the light of the tragedies at Mid Staffordshire and Winterbourne View, it is clear that some of the mechanisms for ensuring accountability and transparency in the NHS must be reviewed. Safeguards need to be put in place to make our NHS more accountable. That means listening to the concerns of patients, heeding the advice of NHS staff, and ensuring that whistleblowers are correctly protected.
	Patients have always been, and always should be, at the centre of the NHS. It is true, of course, that the discoveries made at Mid Staffordshire do not represent the typical experiences of NHS patients, and that nurses and doctors deliver great care for patients every day, but it should not be possible for the failings of Mid Staffordshire to be replicated. If such failures are to be prevented in future, patients’ voices must be heard, and patients must receive clear assistance and information about their treatment.
	Figures from the national cancer patient experience survey show that only 64% of patients felt they were able to discuss their concerns and fears with staff in the hospital, and that just over 50% were given information about the financial support to which they were entitled. While the survey goes a long way towards ensuring that there is more transparency, some of those figures are worrying. A large proportion of cancer patients still feel that they are not given sufficient information, or that they are unable to relay their concerns to those who are caring for them.
	We welcome the creation of bodies designed to establish greater accountability to patients and the public by giving them a stronger voice in the Health and Social Care Act 2012. However, many councils across the country are still unsure whether they will have a running local HealthWatch in coming months, or have not even signed contracts with organisations to run it. These bodies are crucial in providing accountability for NHS patients; without them, the public does not have a voice.
	One of the main reasons for the failings at Mid Staffs is the existence of a culture of covering up mistakes. Those who tried to speak out were bullied, hassled and silenced. It is crucial that NHS staff are allowed to voice their opinions without fear of unjust repercussions.
	The previous Labour Government made huge inroads in helping NHS staff raise their concerns and in protecting their rights. These have, however, not being sufficient. I also have to commend the Secretary of State’s timely decision to ban gagging clauses in severance agreements. However, should not the Government be making it easier for NHS staff to voice their concerns while they are still in employment? We have seen many examples of consultants, doctors, nurses and other staff who spoke out about the failings of Mid Staffs and who were persecuted and struck off for doing so, and about NHS staff who felt unsupported and bullied by their supervisors to hide their concerns.
	I must mention the case of Dr Narinder Kapur, one of Britain’s leading neuropsychologists and now campaigner for fairer treatment for whistleblowers. Out of his moral and ethical responsibility as a doctor, Dr Kapur alerted the NHS of certain failures he observed within his department, such as under-qualified, unsupervised staff treating patients and putting them at risk. His dismissal by the Cambridge University Hospitals NHS Foundation Trust was ruled unfair, but he still was not reinstated. This man, who was one of the best neuropsychologists in the country and was trying to help his patients and make his hospital a better place, was left penniless and lost his home.
	The Government need to do more to ensure that NHS staff who blow the whistle on unethical practices do not receive the same treatment as Dr Kapur, and are protected from such persecution. Hard-working consultants, doctors, nurses and other staff who want to make the NHS a better place should not fear for their jobs and should not be bullied by their supervisors. Patients should be assured that they have recourse for complaints and that their voices will be heard. What will the Government do to protect patients and change this culture of covering up and bullying, to ensure that we do not have another Mid Staffs and to make the NHS more transparent?

Steven Baker: My constituent Edward Maitland was a frail man who could not eat solid food following tongue surgery. He was admitted to Wycombe hospital from his warden-controlled accommodation suffering from dehydration, shortness of breath and weight loss, things from which he should have recovered. His son, a paramedic, clearly explained on his father’s admission that Mr Maitland could not eat solid food and he also provided liquids. About three weeks later Edward Maitland had died from aspiration pneumonia. At the post-mortem, Weetabix was found in his lungs.
	Of course, the investigation was taken extremely seriously and the documentation is, up to a point, very professional. Under “root cause”, it states:
	“The investigation found that there is no evidence to support robust communication between nursing and medical staff…No SBAR”—
	situation, background, assessment and recommendations—
	“documentation was used in EMC or in handover to Ward 6B this would have highlighted the patient’s nutritional needs.”
	It proceeds to make some “recommendations”, but I want to highlight the “lessons learned”:
	“To care for all patients with a holistic approach and the multi-disciplinary team must focus on all health concerns.
	Better communications between all staff members, this should be ongoing and involve all the different professionals who may need to collaborate the care delivery plan. This collaboration and communication should involve the patient, family and the healthcare staff.”
	Unfortunately, that is bread-and-butter, typical stuff—and managerial gibberish.
	What I learned is that two words would have saved the life of Edward Maitland: “no solids”, written on the records at the end of his bed, on his wristband, and above his bed. The situation in his case is very simple. A man died who ought not to have died. He should not have died in these circumstances.
	I have the hard task of saying, therefore, that I look to the courts, and the Francis report helps me. Recommendation 13 of the report, on fundamental standards, refers to:
	“Fundamental standards of minimum quality and safety, where non-compliance should not be tolerated. Failures leading to death or serious harm should remain offences for which prosecutions can be brought against organisations.”
	Elsewhere, the report discusses at some length—I do not have time to go into detail—a regulatory gap in relation to the Health and Safety Executive:
	“It should be recognised that there are cases which are so serious that criminal sanction is required, even where the facts fall short of establishing a charge of individual or corporate manslaughter. The argument that the existence of a criminal sanction inhibits candour and cooperation is not persuasive. Such sanctions have not prevented improvements in other fields of activity.”
	I took legal advice. I approached a retired circuit judge in my constituency, who in turn approached a firm of lawyers. I am most grateful for the guidance of Kate McMahon, of Edmonds Marshall McMahon, who has provided me with considerable free legal advice in relation to this case. The firm specialises in private criminal prosecutions. She has explained that, at least at the preliminary stage, there may be a corporate manslaughter case to answer, and liability for gross negligence manslaughter may well be attributable to one or more employees of the hospital.
	I do not want people to be prosecuted unnecessarily, or to see taxpayers’ money wasted, but I do want accountability, and I believe that in the end the courts provide that crucial accountability. Edward Maitland’s son Gary now has this advice, and I have left it to him to decide whether to approach the police. I have briefed the police superintendent in Wycombe on the circumstances. I believe that the courts should be the ultimate way of sanctioning the NHS. Francis agrees, and I hope he will provide a policy in this area.
	There should be more democratic control. I am delighted—

Frank Dobson: Does the hon. Gentleman not agree that one characteristic of involving lawyers is that there is a lot of money around, and it goes to them? Would it not be better spent trying to ensure that performance standards are enhanced, rather than employing lawyers to have a go at the people who got it wrong?

Steven Baker: Of course I would rather that the money was spent on standards and performance and not on prosecutions, because I would rather the problems did not occur. I do not wish to lecture the right hon. Gentleman, and I feel sure he did not quite mean it this way, but if we do not intend to apply the law of corporate and individual gross negligence manslaughter, let us repeal it, or amend it so that it does not apply to the NHS. I have to say to the right hon. Gentleman that it does apply to the NHS and that in certain cases, as Francis has said, things are so bad it should be applied.
	I ask the Government to look at democratic control. I am delighted that the Secretary of State is reforming the Care Quality Commission, but how can we make sure that there is more direct accountability, perhaps to the health and well-being boards, and the overview and scrutiny committees? How can we give them the power to sanction or perhaps even, through due process, dismiss a board or a chief executive?
	I think here of Paul Ryan, a man with vascular disease who had lost one leg already when he found himself sick. He had four days of GP visits and spent nine hours in accident and emergency on a Friday. He was then sent home, having had an MRI scan, after which he was expecting to lose his leg on the Monday. He was told to expect a phone call, but no phone call came. The Ryans eventually called 999 and were told that it was better to get a GP. The GP arrived and called an ambulance. It took two hours for that to arrive and Paul Ryan died in the ambulance with his wife on the way to hospital.

William Cash: Does my hon. Friend agree that accountability does reside also with the Secretary of State, as set out in the national health service legislation? That is essential in relation to our functions in this House and those of this Secretary of State and former Secretaries of State.

Steven Baker: I am grateful to my hon. Friend for his point, although it has been examined at length, so I do not want to go down that rabbit hole with him—I hope he will forgive me.
	The post-mortem on Mr Ryan indicated that he probably would have suffered the same fate in any event, but the system let the Ryans down—Mrs Lyn Ryan made that point to me and to the local newspaper.
	Unfortunately, the case plays right into the fears of the public in Wycombe, because we lost our accident and emergency facility in 2005 and we recently lost our emergency medical centre. We have just had two similar repeat occurrences of the minor injuries unit failing to refer people across the car park into the excellent cardiology and stroke units. We have seen an enormous range of little problems, for example, an 85-year-old lady with dementia was sent home in a taxi at 2 am in just her hospital gown. This cannot go on, and the public’s concerns are justified. The trust is being investigated by Sir Bruce Keogh and although I have heard good reasons why its mortality levels are justified—they relate to running hospice care, in particular—this must be taken as an opportunity to improve things.
	Finally, I wish to make a point on transparency. Yesterday, I spoke to Anne Eden, the chief executive of the trust. I am not going to put on the record the entire content of the conversation, but when I told her that I intended to raise this issue of corporate manslaughter on the radio this morning, I was told, in terms, “To protect the reputation of the Buckinghamshire trust, legal action would be sought.” This is a matter of public interest being raised by a Member of Parliament in good faith, but I have had to—[Interruption.] To be fair to her, she was talking about the radio. But I have had to rely on privilege to protect myself from being sued on this matter. It is not acceptable that such a matter should have to come to a Member of Parliament, simply to rely on privilege. The situation reinforces something I have experienced again and again since becoming an MP: second-hand rumours and half-truths about the state of health care in Buckinghamshire. I have encountered: people stymied; people thinking it is helpful to give half a rumour to a friend to repeat to me so that I can know how bad things are; and people’s frustration at not being able to do anything. I know that Buckinghamshire Healthcare NHS Trust is obviously close to your heart, Mr Speaker. I know that it expects to satisfy Sir Bruce Keogh, but it is really time for proper accountability and that must include the courts.

Andy Slaughter: Two NHS stories were leading the news this morning, both of which are relevant to the subject of this debate. The hon. Member for North East Cambridgeshire (Stephen Barclay) and my hon. Friend the Member for Ealing, Southall (Mr Sharma) have talked about the important issue of whistleblowers. I want to talk about the other subject, which is the conflicted interests of clinical commissioning group members.
	All hon. Members should be grateful for the British Medical Journal report that was the basis of this morning’s new stories. In case anyone has not seen it, let me read the headline points. It states:
	“More than a third of GPs on the boards of the new clinical commissioning groups (CCGs) in England have a conflict of interest resulting from directorships or shares held in private companies”.
	It continues:
	“conflicts of interest are rife on CCG governing bodies, with 426 (36%) of the 1179 GPs in executive positions having a financial interest in a for-profit private provider beyond their own general practice—a provider from which their CCG could potentially commission services.
	The interests range from senior directorships in local for-profit firms set up to provide services such as diagnostics, minor surgery, out of hours GP services, and pharmacy to shareholdings in large private sector health firms that provide care in conjunction with local doctors, such as Harmoni and Circle Health.
	In some cases most of the GPs on the CCG governing body have financial interests in the same private healthcare provider.”
	Yet the cheerleader for the privatisation, Dr Michael Dixon of NHS Alliance says:
	“The priority is to move services out of hospital and into primary care. The reason this hasn’t happened to date is because of blocks in the system. It’s more important to remove those blocks than be preoccupied with conflicts of interest.”
	I say that the British Medical Journal has done a good job, but it has only just scratched the surface. I shall refer to my own experience of trying to get to the bottom of this matter in north-west London.
	On 10 November an article by the social affairs editor of The Guardian began:
	“Five family doctors have this week become millionaires from the sale of their NHS-funded firm to one of the country’s biggest private healthcare companies in a deal that reveals how physicians can potentially profit from government policy in the new NHS.”
	It went through the individual shareholdings of those doctors who had sold out to Care UK and it continued:
	“Another winner seems to be NHS reform champion Ian Goodman. The north-west London GP chairs the Hillingdon clinical commissioning group and was also a board director of Harmoni. He could make as much as £2.6 million.”

John McDonnell: This Dr Goodman chairs my local CCG and tried to force Hillingdon hospital to put £13 million of operations out to tender, which would have destabilised the whole hospital. I pay tribute to the Treasurer of Her Majesty’s Household, the right hon. Member for Uxbridge and South Ruislip (Mr Randall) and the Parliamentary Secretary, Cabinet Office, the hon. Member for Ruislip, Northwood and Pinner (Mr Hurd), who joined me in preventing that from happening. It would have meant Hillingdon hospital being financially destabilised in the long term.

Andy Slaughter: I am grateful for that. I did a company profile for Harmoni. It revealed that, although he might have sold his shares for that amount of money, Dr Goodman is still listed as head of clinical spine. A series of press articles deals with the failings of Harmoni—failures that have caused deaths through under-staffing or poor-quality staffing—and why it is under investigation.
	Let me return in the time I have available to my attempts to get to the bottom of the matter. The same day as I read the article in The Guardian, I wrote a short letter to the chief executive of the NHS in north-west London. I said:
	“I attach the front page article from today’s Guardian, which you may have seen, regarding the sale of out of hours GP service provider Harmoni to Care UK. The article states that a number of GPs will make substantial sums from the sale.
	I note that four of the CCG chairs in NW London declare shareholding or directorship in Harmoni, as does your Medical Director. It would be helpful to know if they are beneficiaries of the sale and by what amount.”
	I then asked for assurances as to the future.
	A month later I received a non-reply reply, the most relevant sentence of which was:
	“Any member who declares an interest in a meeting is expected to take no part in discussions and step out of the meeting.”
	I wrote back a much longer reply, in which I pointed out that the chair of the Royal College of General Practitioners had said:
	“it is not about excluding yourself from the room whenever there is a discussion; it is about how it will drive your decision-making overall”.
	I pointed out that, as a consequence of hospital closures in north-west London, there had been a shift in funding from hospital to primary care, a greater involvement of private companies in the primary care sector, and an opportunity for those companies to increase their profits by cutting back on the level of service offered.
	I principally raised the fact that the information that should be provided is not provided on declaration of interest forms, especially the scope and value of any interest. I listed doctor by doctor and CCG chair by CCG chair what those interests were and how they were not adequately declared. I dealt with seven out of the nine CCG chairs and the medical director. That was in a letter on 20 December.
	I received a reply on 3 February which said:
	“The Cluster does not hold this data.”
	So three months on from my original inquiry, I am none the wiser in relation to these matters.
	I advise any hon. Member to look at their CCG declarations of interest online—not Hillingdon, because it does not publish them online. I use Hammersmith and Fulham as an example here. The husband of one member is a partner of Drivers Jonas Deloitte. The first thing I found on the website of Drivers Jonas Deloitte was that it had been appointed to sell the Kent and Sussex hospital in Royal Tunbridge Wells when it closes in 2011. Another member is the owner of a provider of home care services. Another is the brother of the director of a design company that holds a number of contracts with NHS organisations. It might be that none of them has a direct financial pecuniary interest now or in the future, but it shows touching naivety, complacency or worse.
	Before the 28 members of the joint PCT board made the decision to close the four A and Es in north-west London, I said at the public meeting that if any of them had or was likely to have interest of a pecuniary nature they should not take part in that decision. One of them rather touchingly volunteered the information that they had sold their shares. What world are we living in when a third of GPs on the new CCGs can hold financial interests in anything from land sales to an alternative provider?
	I raised the question with the Prime Minister yesterday and mentioned Dr Goodman, although not by name, and his estimated minimum return of £2.6 million. Again, I got a non-reply in reply. Sooner or later the Government will have to address these matters.
	There is another story in the Daily Mail today that states:
	“In 1981 there were eight NHS press officers in Britain. Now there are 82 in London alone”.
	It is not that there is a lack of spending on publicity in the NHS. Indeed, almost £1 million has been spent on a private consultancy firm simply to carry out the bogus and botched consultation on the closure of A and Es.
	We are seeing the creation of a second-grade health service in north-west London.

Barbara Keeley: A number of months ago, I raised the case of a person who rejoices in the title “NHS head of brands”. There seem to be a whole set of units that keep cropping up.

Andy Slaughter: I am sure that all Members will have similar examples. It is an obscenity that millions of pounds are being spent on spin and disinformation while basic information is not being provided even to Members of Parliament after three months and persistent requests. Sooner or later, these issues will have to be addressed.
	Of course, our main preoccupation is to maintain our first-rate health service—our blue light A and Es, our stroke centres and our major hospitals—rather than having it replaced by urgent care centres and minor primary care facilities. That is what we face in north-west London and, I am sure, around the rest of the country. It adds insult to injury if the individuals who are making the decisions to sell the land and to transfer services into the private sector are also the shareholders and owners or if they benefit in any other way. This is a corrupt act and it must be addressed by the Government. They cannot continue to turn a blind eye to it.

Several hon. Members: rose—

Nigel Evans: Order. Eight Members are trying to catch my eye and we will finish at 5 o’clock, with Charlotte Leslie having the last two minutes. In order to accommodate everybody, as well as interventions, the time limit is now five minutes.

Andrew Selous: The NHS saved my life when I was 24 with an emergency operation in the middle of the night. It was there for me when I needed it, which is why I care so deeply for it.
	We have heard some bad examples of what goes on in the NHS, but there are also many examples of excellent care in the NHS every day. NHS staff, especially nurses on busy wards, work extremely hard. They often rush around, have to miss their breaks and get home exhausted. We must all acknowledge that.
	Today, we are debating what happened in Mid Staffordshire, but, as others have said, it was, sadly, not an isolated case. We know that 6,000 deaths in 14 other hospitals are being looked at. One area that no other Member has mentioned so far today is the training of our nurses and our doctors. Of course we want our nurses and doctors to be professionally well trained, but it is important that they do not just have academic skills. However good their biology, chemistry or maths, if they are not kind, if they are not compassionate and if they are not caring individuals, perhaps the people responsible for their training need to say to them that a career in the NHS might not be the right career for them and that research or something else might be more appropriate.
	The most worrying thing that I have heard in the debate today is the comment that was allegedly made by a nurse to a patient and that was quoted by the right hon. Member for Cynon Valley (Ann Clwyd): “I am a
	graduate, I don’t do sick.” That is not acceptable. Other Members may also have read the article by Charles Moore in
	The Daily Telegraph
	a number of weeks ago, in which he looked in detail at whose job it is to make sure that patients are cleaned up if they need to go to the lavatory and do not get there in time. The faculty of health sciences at Southampton university made the point that ward sisters always have this responsibility, but went on to say that it is everyone’s job.
	When I go round a school, I find that if a head teacher picks up the litter on the ground, surprise, surprise, there is not a lot of litter. When a doctor, however senior, sees a patient to give a diagnosis or a prescription, if that patient needs basic nursing care, no level of seniority in the NHS should be above that. That would send a powerful message that that was everyone’s job, as the faculty of health sciences at the university of Southampton said.
	I am pleased that in Bedfordshire clinical commissioning group, the excellent Dr Paul Hassan has told me that there will be unannounced GP visits to the wards of the Luton and Dunstable hospital and other hospitals to which Bedfordshire sends its patients. There will be private TripAdvisor-style patient reports coming back—not report forms handed by a sister to a patient and filled in while the sister is leaning over them, but done genuinely in privacy so that GPs can get a proper report of what is happening. There will be real-time alert buttons on the keyboards of GPs and clinicians so that they can flag it up immediately if things are going wrong. That is excellent. That is the way to get an early indication of what is going wrong.
	In addition to outstanding nursing care by caring, compassionate nurses, we need clinical leadership. We need the medical directors and the chief nurses of hospitals to step up to the plate. We need medical directors who are front-line clinicians—that is really important—and we need hospital boards to make sure that they have the proper data. Data on bedsores, for example, should be available at every trust board meeting. If the incidence of bedsores is increasing, that may be an indication that things are going wrong in the hospital. That information should be seized on and acted on urgently.
	Above all, we need the medical director and the boards of hospitals to foster an esprit de corps and to create an understanding among all the staff that “we don’t do average” and that excellence is what they should aim for. We need a culture where peer review and challenge are normal, natural, accepted and of benefit to everyone. In that vein I commend the “Getting it Right First Time” report by Professor Tim Briggs, which is looking at a clinically-led hub and spoke peer review model in orthopaedics. That could usefully be extended across the whole of the NHS.

Bernard Jenkin: I am encouraged by the speech from my hon. Friend the Member for South West Bedfordshire (Andrew Selous) because it shows that accountability is not just about supervising organisations, regulators, targets, safeguards, mechanical things and statistics. Accountability is about creatively getting the intelligence into the system about what is happening and reacting to it positively, welcoming
	it and generating the complaints so that more intelligence comes into the system. That is the kind of accountability we want.
	As Chairman of the Public Administration Committee, I feel I can add a new dimension to the debate because of what we are thinking about in our inquiry on the future of the civil service. We need to ask ourselves, “What does accountability feel like?” We think we know what accountability feels like, but my goodness, it goes up and down a bit. During the previous Parliament we felt very accountable in some periods, every single one of us. What do we want accountability to feel like in the health service? With the greatest respect to my hon. Friend the Member for Wycombe (Steve Baker), the lawyers must be the last resort. We do not want accountability to be about finger-pointing, blame and holding people to account. Indeed, that is part of the disease that afflicts the health service. We want accountability to be about nursing staff on the ward feeling accountable to each other for sharing information, accountable to the patients and welcoming the information they receive from them, and accountable to their managers and holding them accountable for what they do not feel is being done, in an atmosphere of trust and co-operation.
	What is chilling about the Mid Staffordshire story is the question of what accountability felt like in that hospital at that time? To whom did people feel they were accountable? What did they feel they were accountable for? There must have been an almost an atmosphere of “Apocalypse Now” in the hospital, in which nobody knew where to turn.
	In the evidence we are receiving about the civil service, we have had powerful testimony from an adviser to our Committee, Professor Andrew Kakabadse of Cranfield university, who rather chillingly points out an obvious truth. Very few people who work in a failing organisation do not know that it is failing. Most people in a failing organisation know that it is failing. What is wrong? The answer is that they do not know how to talk about it. They do not know what to say, who to tell—or, if they try to tell people, it will be bad for them—or what to do. So people often just leave failing organisations, saying, “I can’t do anything about it.” I bet most of those on the board of the hospital trust knew it was going wrong and did not know what to do. There is this idea that this was just an isolated case, but it represents a systemic failure. There is absolutely no escaping that.
	I remember the Paddington rail crash. One’s instant reaction was, “Well, the driver went through a red light; it must have been his fault,” but everybody knew that there must have been something much more fundamentally wrong. Something was wrong with rail safety. In aviation, when there is a plane crash, it is very rarely the pilot’s fault. Even if it is down to pilot error, that will be down to pilot training and that will be a system failure. We need to look at this issue in an holistic and sensible way.
	The reaction of the NHS to the Francis report was immediately to reach for statistics and to start doing things. It immediately started a storm around our local hospital, the Colchester General, by latching on to one statistic and naming it as one of the hospitals being investigated, even though—I have written to Andrew Dilnot at the UK Statistics Authority and got a reply from him—a single statistic should never be used in such a fashion. In fact, the Colchester General is in the
	top quartile of its class of hospital, so that was entirely unnecessary. My wife has just had a knee replacement in that hospital. I was completely confident that she would get good nursing care and she indeed got very good nursing care.
	There is now an uncomfortable atmosphere surrounding this issue. There is an atmosphere of denial, and this relates to Sir David Nicholson. Is he still in denial? Is the system still in denial? Can the system change dramatically enough unless people are seen to take responsibility for the culture? It is difficult to argue that he has not been individually responsible for the broad culture in the national health service that has led to this pass.

Nigel Evans: I am sure the House wishes Anne Jenkin a speedy recovery.

Jackie Doyle-Price: It is a pleasure to follow my hon. Friend the Member for Harwich and North Essex (Mr Jenkin) and give a south Essex perspective on this issue by speaking about the Basildon and Thurrock Foundation Trust. It was found to have significant failings and high mortality rates in 2009, which led to regulatory intervention, on which the right hon. Member for Leigh (Andy Burnham) will recall delivering a statement to this House. At that time, the Care Quality Commission voiced its lack of confidence in the management at Basildon, but there was no change and no one was held to account.
	As we all know—and as my hon. Friend has eloquently explained—institutions fail when they are poorly led. In the event of failure, senior management need to step up to the plate, either to take a grip of matters and force change or to take responsibility. The failure in accountability at that time has no doubt held Basildon back. Subsequent CQC inspections found Basildon failing in terms of care and welfare, safety of premises, safety and suitability of equipment, nutritional standards, dealing with serious incidents, record keeping and cleanliness. That is simply not good enough.
	When I challenged the hospital management, the response was invariably, “We’re no worse than anyone else; we just get more scrutiny.” Indeed, in one letter the then chief executive criticised the sensational reporting of some unnecessary deaths at the trust and asked for my assistance in acquiring more positive media coverage, a clear example of the complacency to which the Prime Minister referred when he made his statement to the House on the Francis report. There simply has not been sufficient urgency in addressing weaknesses. That led me to conclude that the trust would not improve without a change in leadership—the same conclusion the CQC reached in 2009.
	I also have some wider reflections on the systems of governance. At Basildon, the board clearly failed in its duty to provide effective challenge and to hold the management to account. I think that we need to give a clear indication to directors of foundation trusts that in the event of poor performance, the buck stops with the board. They are accountable and they need to accept that responsibility.
	I must say that I found the CQC a very positive ally in seeking better performance at Basildon. I know that it has been criticised by some Members, but my feeling
	is that its powers were quite limited. It certainly had no power to hold senior management to account, a power that is reserved for Monitor. My right hon. Friend the Secretary of State has made his comments about the CQC, but I think that he really needs to look at Monitor. In my experience, the work of Monitor has been very disappointing. In Basildon it was not keen to take any enhanced action. Its view was that the trust was not doing as badly as it had been in 2009 and so the direction of travel was positive, even though it was failing to meet the basic standards of care that the public should be able to expect. I do not think that is good enough. It goes to the heart of what we are debating today: the collective failure of institutions in the NHS to hold people to account when things go wrong. I urge my right hon. Friend to look at whether Monitor is really fit for purpose.
	Since I started challenging Basildon and Thurrock NHS Foundation Trust, I have been very heavily criticised, as if by holding the hospital to account for its performance I am attacking the NHS and its staff. The contrary is true. If we really believe in the NHS and in providing the best possible health services for our constituents, we must challenge it when things go wrong. We should have zero tolerance of failure. Do we not owe it to the staff who do their job well to ensure that those who do not are disciplined and held to account for poor conduct?
	Thankfully, Basildon and Thurrock NHS Foundation Trust is now under new leadership. There are new non-executive directors who will provide a challenge. We have a new chairman, a new chief executive and a new medical director, and I am encouraged by the messages I have received from them. However, when senior management have been excusing poor practice for so long, there is a need for profound cultural change to get things fixed. An NHS with a stronger emphasis on accountability would have allowed us to start that process in Basildon so much sooner and to save many lives.

Christopher Pincher: I would like to make two brief points. First, will my right hon. Friend the Secretary of State, when he comes to review the Francis report, heed the cause of Robert Francis, and indeed the passionate appeal of my hon. Friend the Member for Wycombe (Steve Baker), by extending the provisions on criminal liability so that in the final analysis charges of wilful obstruction of complaints and wilful neglect can be preferred? Had such sanctions been in place 10 years ago, we would have seen charges preferred at Mid Staffordshire, and then we might have seen the interesting spectacle of Ministers and former Ministers being called to the witness box to give evidence in defence of those public officials who were claiming that they were only obeying orders and pursuing the policies of their political masters. I think that sort of sanction would be enough to focus the minds of any Minister, past and present, even those who wriggle and twist to try to avoid their responsibilities.
	Secondly, I wish to make a point about culture change. We have had the report and the debate, but it would be foolish to assume that there have been any great strides forward as part of a culture change in Staffordshire. I will give one example. After the Francis report was published on 6 February, South Staffordshire PCT issued a press release which said:
	“Much has been learnt”—
	that word again—
	“since 2009 and the PCT now operates with quality at the centre of all that we do.”
	My constituent Tom Berry might take issue with that statement. Tom is a gifted young man who is pursuing a degree at Wolverhampton university but suffers from spinal muscular atrophy, which means that he can barely move. He has round-the-clock care from a team of carers. When he needs to cough, those carers have to compress his torso—that is the kind of help that he needs. However, those at the Staffordshire NHS cluster seem to have forgotten his needs and want to change his care package, against his wishes, against the wishes of his family and carers, and against the advice of his GP. I have tried to help him, but the head of continuing care in Staffordshire refuses to answer my letters and hides behind lawyers in refusing to acknowledge my calls to heed the advice of Tom’s GP.
	When I threatened to blow the whistle on that conduct in this House, I secured a conference call from the chief executive of the Staffordshire NHS cluster, Graham Irwin. He did not bring to that conference call the head of continuing care, or a clinician, or a carer—he brought his press officer, which suggests to me that, in Staffordshire, medical care runs second to media management. Although he was very insistent that Tom’s care package should still be changed, he said that he did not even know whether a proper impact assessment had been done on the effect of that change on Tom’s health. He said that he would go away and look into it, but three weeks later, after another phone call and another letter, we still do not know what is happening.
	If Francis is right when he said that our
	“comfortable set of assumptions about the NHS have been misplaced”,
	he is certainly talking about what is going on in Staffordshire now. We still have a culture of complacency allied to determined obfuscation. I say to my right hon. Friend the Secretary of State that if we are to restore the battered credibility of care in my county, we need to ensure that we put patients, and not the godhead of targets, front and centre. We need to ensure that we recruit, recognise and reward the best people and sack the worst people. As my right hon. Friend the Member for Mid Sussex (Nicholas Soames) said, we cycle too many bad people through our public services. We need to make sure that when there is wrongdoing, people are punished not in the court of public opinion but in a court of law. If we do that, we can rebuild and restore confidence in our health service in Staffordshire, and we will have a system about which we are prepared to blow the trumpet, not blow the whistle.

Tracey Crouch: I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie) on securing this very interesting debate, which has covered lots of issues to do with accountability and transparency, not only at Mid Staffordshire but throughout the entire country. It is clear from the speeches by the right hon. Member for Cynon Valley (Ann Clwyd) and my hon. Friend the Member for Wycombe (Steve Baker) that these concerns go beyond the appalling events at Mid Staffs. My own constituents need reassuring about their patient care, the quality of the information they are receiving and,
	unfortunately, the mortality rates at Medway Maritime hospital. Like other hospitals, it is now under investigation, and we await the outcome with interest.
	It often takes a very long time for the truth about these matters to be completely uncovered. In the past, the quality of patient care has, in many respects, been secondary to the hospital meeting its targets. That is a shame, and it is part of the culture that we need to change. I do not want to believe that there is a culture of cover-up in the NHS. Like my hon. Friend the Member for Totnes (Dr Wollaston), I think that all those who work in the NHS—the nurses, the doctors and the consultants—do a brilliant job in delivering good quality care and the best patient outcomes. Unfortunately, that was not the case at Mid Staffs, and concerns about quality of care and mortality rates are spreading. As I have said, constituents are now concerned about the care they receive at the Medway Maritime hospital.
	The trust is always incredibly good at responding to my questions, whether they be about what I consider to be the high use of the Liverpool care pathway at the hospital, constituent complaints, dementia care or specific patient services. However, I fundamentally believe that if a constituent has to involve an MP in a complaint, the system has failed. There is a growing perception that if someone complains, it is their fault and they are in the wrong, while the hospital paints itself as the victim of the complaint rather than the other way around. That is wrong.
	The Medway Maritime hospital is under investigation for higher than expected hospital standardised mortality rates, and there is currently a specific outlier alert on septicaemia. Worryingly, this is not the first time this has happened. Discrepancies in coding were highlighted way back in 2008 with the discovery that 8% of deaths were being recorded as end-of-life care when the proportion should have been 37%. Adjusting the mortality index to exclude those deaths reduced the hospital’s score by more than a third. A clear manipulation and distortion of the information only served to damage the best outcomes and services for the patients. I hope that that will not happen again. However, as an outsider it appears to me that the complexity of coding is part of the problem with the lack of transparency.
	A culture of bullying and its suppression within the NHS has been mentioned. The latest staff survey at the Medway Maritime hospital shows that there is still a perception that bullying is widespread. If we want to improve standards in patient care—which is a key aspiration for the newly restructured NHS—that has to be one of the most important issues to address. I welcome today’s announcement by the Secretary of State, but may I make a practical suggestion that was put to me by a GP this morning? One of the problems with the system for complaints is that they stay within the hospital—they go up to the management board and do not really go beyond it. Instead, complaints could be delivered on a quarterly basis to the new clinical commissioning groups, which would enable people outside the hospital structures to look at potential trends and patterns of poor quality, and at whether there are concerns about specific consultants. We could end up taking the responsibility from the hospital, having the outsider look in, and making more practical changes.
	Greater transparency in the NHS is not just about honesty and accountability, but about better communication. As the most recent ombudsman report highlighted, the common pitfalls are also the result of equivocal language over care, the use of technical language and the failure of insincere apologies. We need to learn the lessons of the Francis report; patients from those families who use my local NHS services deserve nothing less.

Nick de Bois: I will never forget the last time I saw my mother. It was three days before the general election in 2005. She had secondary cancer, but she was a fighter, though I make no comparison between her circumstances and the Francis report and the horrors that people went through at Stafford.
	There are many reasons why someone might remember the last time they saw their mother, but my experience is overshadowed by a sense of guilt. During my mother’s long stay in hospital—she had been in and out—my brother, who lived abroad, had often been with me and he persistently picked up that the pervading culture on the ward was that he who shouted loudest got attention. My mother would describe how much pain and discomfort she was in—other Members have mentioned similar problems—and say, as elderly people do, “Don’t make a fuss.” To his credit, my brother dealt with it by shouting loud. On that last day, my brother was not with me because he had returned abroad. Unfortunately, I did not shout that day. I went back to the election and my mother sadly died. I am not drawing a comparison with what happened in Stafford, but many patients and relatives will recognise that one has to shout loudly to get heard. That points to a problem with the culture.
	In 2005, to their credit, the last Government were increasing spending on the health service. However, that suggests to me that the answer to improving outcomes and care is not about money. We can pour a lot of money in, but it will not do the trick. It has its role, but it is not the final driver. I hope that one of the legacies of Francis will be that we can recognise that the debate needs to move on. It should not be a bidding war between different political parties and ideologies about money. It should be about the thing that matters most: will patients get better, will they receive quality care and will they be treated with respect and dignity, come what may? If we drive a mature debate in this country, we can achieve outcomes on that basis.
	As Opposition Members have said, perhaps we can step aside from politics. I am not naive and I do not believe that that will happen. However, every time we debate these matters, let us remember that we have a far greater chance of achieving what we are here to do, which is to provide a health service that is the envy of the world, if we have a mature debate. I say cautiously and with respect that in the light of Francis, our health service cannot currently be the envy of the world, but its ideals are most definitely the envy of the world. We have a duty in this place to set the standards that will make it the envy of the world once more.
	I am very conscious of the time, but I would like to make one quick point. We have heard a lot about the culture, but we cannot change it just like that. Culture is thoroughly and utterly inbred within any institution. It starts with the new people it trains—the includes the
	people who are there now—and it touches everything that it does. Everything that an institution does should reflect its culture, and changing the culture therefore takes time.
	Where I disagree with some in this House is in my belief that leadership is where culture starts. This House, managers in hospitals and trainers all have a role to play. However, every time I consider the role of the current chief executive, Sir David Nicholson, I come back to the point that although he has voiced sentiments that I welcome in that he said that to achieve care we need an open, transparent and care-led culture, that it is vital for staff to be seen as an asset, and that it is vital for staff to be able to challenge their leaders, the reality is that he is a command-and-control manager. That is his legacy and others have paid a price for it. I believe that his departure, whenever it may happen, is absolutely necessary to change the culture because we need to start at the top and feed it throughout the business. I say that with a heavy heart, because I do not believe that we should be chasing scalps. However, as I said at the beginning, we should be chasing the ultimate outcome of serving our patients and that is one way of doing it.

Neil Carmichael: This debate has been thorough and, at times, moving. I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie) on securing it. I was impressed by the moving speech of the right hon. Member for Cynon Valley (Ann Clwyd) because it demonstrated the tragedy that lies behind this debate.
	The Francis report is a disturbing document in many ways. The Prime Minister and the Secretary of State for Health are right that we should not be looking for scapegoats. I do not want us to find any scapegoats and I am sure that you, Mr Deputy Speaker, do not what us to find any scapegoats. We must remind ourselves what a scapegoat is: it is somebody who gets the blame for somebody else’s behaviour. The question that we must ask is who is responsible. That is at the core of this debate. If we cannot find out, we must produce a system that has a mechanism for responsibility.
	When someone accepts responsibility, it is refreshing and empowering. If a manager avoids that responsibility, they are effectively acknowledging that they are weak and insufficient at their job. If someone cannot answer those questions and does not feel able to say, “The buck stops with me”, they are not doing their job properly. We need to think about that system of responsibility and accountability.
	Can gagging be consistent with effective, decent line management? Absolutely not. A person is effectively saying that someone beneath—or even above—them cannot say what they need to say. A show cannot be run with that kind of mechanism, and we should certainly not be content with the number of gagging clauses we have heard about today. I welcome the end of gagging clauses, and pose the same question that others have asked the Secretary of State: is the move retrospective?
	Line management is also about culture because we must be able to trust people when we ask for something to be done, and know that the message is getting out and is clear and fair. That is what good management is. It is not just an issue in the health service; it is an issue in any organisation, and that brings us to the overall
	question of governance. Governance applies everywhere and must be accessible, transparent and something in which people have confidence. As hon. Members have pointed out, there is far too much buck-passing and evasion, and that will not help us arrive at a decent culture for patients, which is what we should be focusing on. Of course we are right to talk about “patients” rather than “targets”, but we also need patients to feel comfortable with the system in which they are operating.
	My hon. Friend the Member for Enfield North (Nick de Bois) made a good point about speaking out. Many of us can speak out and do so nearly every day on a variety of subjects. Some patients cannot, however, and need additional advocacy that sometimes does not come easily to them or their friends and family. Just imagine them in a management system in which people cannot listen or talk to each other, let alone take into account the views of patients!
	We must have a change of culture and, as the old saying goes, a fish rots from the head. This is about leadership and shaping a culture that effectively manages to spread out everywhere. That culture must be inclusive, transparent and open and effective at empowering people at every level, rather than shutting them down and isolating them in systems that are too complicated to feel comfortable in.
	Finally, I welcome the appointment of a chief inspector for hospitals. That is a necessary appointment and will make a huge difference. They must, however, look at the leadership of what he, or she, is inspecting. Leadership is fundamental and matters, and we must ensure it is responsible and accountable.

Therese Coffey: It is a pleasure to contribute to this important debate, and I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie), and other Members, on securing it. Transparency and accountability are the hallmark of good governance, but they can involve issues such as whether a patient is on the Liverpool care pathway, whether that is transparent and whether their families know, not solely about the running of a particular trust.
	I welcome freedom of information requests, which are among the most useful tools available to a Member of Parliament trying to secure information on data held by hospitals, ambulance services and so on. It is extraordinary, however, that we must resort to those tools to try to get that information and help in holding the people running our services to account.
	I accept that the NHS is a complex organisation—imagine a hospital that has issues with bed-blockers, social care, or people trying to find a place in a home, or where ambulances are exceeding their handover targets. Those are interlocking issues. I still think, however, that it is important to hold the chief executives and boards of these trusts to account.
	I was late today because I was at a meeting with the chairman and chief executive of our ambulance trust. This is not the first time I have had to work with other MPs to highlight particular failures. In a Westminster Hall debate, I called for the chairman of James Paget hospital to step aside. I have not made that call today. I have asked the chairman of the board to consider carefully the potential issues arising from the CQC
	report that is due to come out at any moment. It is frustrating that in trying to hit the target people often miss the point. The point is to care for patients.
	The Care Quality Commission and Monitor were mentioned earlier. I welcome the changes made by the right hon. Member for South Cambridgeshire (Mr Lansley) to introduce unannounced spot checks by CQC. A lot of issues were unveiled as a result of the changes and that is to be welcomed. I welcome the recommendation to merge CQC and Monitor, as there is a risk of ambiguity over exactly which body is holding people to account. I welcome the move by the Secretary of State to have Ofsted-style inspections. I am sure he will learn lessons and ensure that they are focused on clear issues, and not just on myriad matters that get away from the key point of patient care.
	MPs in the east of England came together and, by speaking to the CQC and providing evidence, we managed to stop the ambulance trust gaining foundation trust status, because of the issue of care. Politicians therefore can and should intervene when there is evidence of things going wrong, and not just accept the initial recommendation of Monitor.
	I pay tribute to David Hill, chief executive of James Paget hospital. He had been chief executive of the hospital before and went elsewhere in the health care system. He came back and within a week I could see that he had made a difference in the attitude to care. A year on, I am delighted to report that all the warning notices have gone and that in the latest unannounced inspection it was given a clean bill of health. That is great news for the patients and great news for the staff. It is a reminder that being brave and being prepared to incur the wrath of people who assume one is attacking the NHS when one is actually trying to defend the NHS and patients, can be worthwhile.
	That leads me on to the matter of the difficult jobs we have to do. We have to remind all our governors and board members that they are there to represent the patients. They should not feel cowed. They should be tenacious in pursuing the outcomes that everybody wants in the NHS. These are not easy times—I appreciate that. Let us not have too much hand-wringing about how hard it is. We all know it is, but I believe that politicians of all parties are here to try to support the people. We will not do that by ducking the reality that we have to be accountable. That is true in this House if we let down our constituents, but it is also true for the members of boards who do not hold their chief executive to account and demand nothing but the best for their patients.

Charlotte Leslie: This has been an excellent debate. I thank the Secretary of State, who has been here for the duration of the debate—as
	indeed has the shadow Secretary of State. I think there can be general agreement that there has been a catastrophic failure of leadership. That was well and forensically expressed by my hon. Friend the hon. Member for North East Cambridgeshire (Stephen Barclay). It is worth nothing that although there may have been instances—there certainly have been—of clinical failures, it is only possible to hold to account those managers who have a medical qualification registered with the General Medical Council.
	We had a blast of reality from the moving and extraordinarily memorable speech by the right hon. Member for Cynon Valley (Ann Clwyd). I thank her, and the people who wrote to her, for sharing their tragic stories. We had powerful and thoughtful speeches from Members involved in the Mid Staffs tragedy, including my hon. Friends the Members for Cannock Chase (Mr Burley), for Stafford (Jeremy Lefroy) and for Stone (Mr Cash). The debate benefited from the experience of Members who have worked directly in the NHS, including my hon. Friends the Members for Totnes (Dr Wollaston) and for Bracknell (Dr Lee), and from the political experience of those such as the right hon. Member for Holborn and St Pancras (Frank Dobson). I thank everybody for their contributions.
	This has been an important debate, in that it has finally provided a voice for many people who have been kept silent for so long. Another lesson that we can draw from it is that it is not systems but people who care in our health service. We can take away from the debate the many mechanisms of accountability and transparency that have been suggested, as well as suggestions of how we can nurture the professionalism and the best instincts of those who work in our NHS. Let that be a mission for all of us. We must also really ensure—perhaps in contrast to what has been done before—that patients are at the very heart of what the NHS is all about.
	The debate has been enormously important, and I hope that it marks the beginning of a consensus and of a cross-party drive to ensure that the scandals and tragedies that we have seen throughout our health system never occur again. I also hope that this marks the forming of a platform for the many people out there who do not have the benefit of parliamentary privilege. It is our duty to ensure that their silence—in many cases, a deadly silence—is ended by this debate and that a new era of transparency and accountability, which should be seen in by a new set of personnel in our NHS, begins here.
	Question put and agreed to.
	Resolved,
	That this House believes that in the wake of the Francis Report it is clear that accountability and transparency are of paramount importance to patient safety and trust in the NHS; and further believes that across the NHS individuals found to have breached those principles should face the appropriate consequences.

Immigration Rules: Sponsors

Motion made, and Question proposed, That this House do now adjourn.—(Anne Milton.)

Nigel Evans: Before I call Kerry McCarthy, I must explain that, at 5 o’clock, the hon. Lady will be interrupted so that the same question can be put by the Whip. It is a procedural thing that will no doubt be looked at by the Modernisation Committee.

Kerry McCarthy: The issue of immigration is, as ever, highly topical—I cannot remember a time in my nearly eight years in Parliament when it was not—but I want to focus today on one specific aspect of the immigration rules that has put some of my constituents in a difficult position. I know from the responses I have received from other Members that it has affected some of their constituents, too. A number of Members have asked me whether I would be prepared to take interventions during the debate, and I am happy to do so.
	The Government have introduced a new minimum income threshold of £18,600 for someone who wishes to sponsor the settlement in the UK of a spouse, partner, fiancé, fiancée or proposed civil partner whose nationality is not that of one of the European economic area countries. A higher threshold applies if the partner—I shall use that term as shorthand from now on—has a child who requires sponsorship, too. It is £22,400 for one child and an additional £2,400 for each further child. There are also rules about adult and elderly dependants, which I do not have time to address here. The British Medical Association, among others, has raised concerns with me about the operation of those rules.
	Significant concerns have also been raised with me about the time it takes to process applications that meet all the rules but, again, I do not have time to address them in detail tonight. I will just say that no newly married couple wants to contend with delays when one partner is trying to join the other in this country, and it would be helpful, and humane, if such cases could be speeded up, especially when they comply with all the rules and it is just an administration problem that is holding things up.
	Today, however, I want to talk specifically about the income limits. I accept, as do my colleagues on the Labour Front Bench in the Home Affairs team, that family immigration rules should be firm, but they also need to be fair. We need to keep the rules under review, and to adjust them as appropriate to deal with possible abuses and to manage migration at acceptable levels. I do not feel that it is right, however, that the rules should be used to prevent those in genuine, loving relationships from being able to share a life together in this country, when one of them is already a British citizen.
	We have always had the “no recourse to public funds” rule, and I have dealt with many cases in which that has proved an obstacle to people wanting a partner to join them here, but I accept the need for such a rule to protect UK taxpayers, provided humanitarian grounds for exception can be applied. We are not, however, talking about cases where the people involved would be dependent on state support. We are talking about cases
	where the sponsor is in work and is a British citizen, but does not earn enough. By way of illustration, I want to outline the details of three cases. My constituents said they were happy for me to provide the details of their cases, but they did not want their identities revealed. I shall refer to them as “Mr X” and so on.
	The first case relates to Mr X, who for 10 years has lived in Thailand with his Thai wife and their three-year-old child in a long-established relationship. He now needs to return to the UK to look after his elderly parents who are recovering from cancer and are no longer able to travel to Thailand—
	Motion lapsed (Standing Order No. 9(3)).
	Motion made, and Question proposed, That this House do now adjourn.—(Anne Milton.)

Kerry McCarthy: As I was saying, Mr X needs to return to the UK to look after his elderly parents who are recovering from cancer. They used to go on a fairly regular basis to visit him, his wife and child, but they are now too ill and infirm to visit. Mr X has a professional job in Thailand, which he has held down for a long time. It is a decent salary according to local rates, but it is not the equivalent of the £18,600 earnings limit in the UK. It is enough to provide him with the same living standards in Thailand as he would have if he were on that sort of salary in the UK—it is obviously a lot cheaper to live there. Under the new rules, Mr X will have to leave his wife behind while he finds work in the UK, which he is not prepared to do—by which I mean not that he is not prepared to find work, but that he is not prepared to leave his wife behind. They are now considering moving to Spain instead, so that he is reasonably close to his parents and it will be easier for his wife to join him, perhaps becoming a Spanish national, which would then allow them to enter the UK.

Kate Green: I congratulate my hon. Friend on securing this debate. She is describing a situation that we on the all-party group inquiry into family migration have heard several times. Does she agree that there is a further nonsense to the situation she describes? If the family is not able to come in and look after the parents, instead of the family providing care, this will pile costs on for public social care and public health services.

Kerry McCarthy: My hon. Friend makes a very good point, as she always does. If I understand the Government’s ideological position on this issue, they want to support families and very much approve of carers taking on responsibility for elderly parents or others within their family network. The rule that we are talking about operates to prevent that from happening.
	The second case features Mr Z and Ms Z who came to see me in my constituency surgery a few weeks ago. They were married in the UK in March 2011. She is British citizen and her husband, who had been living and working in the UK for six years under a valid work permit, is South African. He was in highly paid professional work in the UK, but soon after they married, he was made redundant. Although he could probably have secured another job at a similarly high salary in the UK, they decided to take a chance and move to Cape Town for a couple of years.
	After two years in South Africa, however, they have decided that they want to return to the UK, but the rules changed while they were away. He will not be allowed to join his wife in the UK unless she earns more than £18,600—despite the fact that he is a highly skilled computer programmer who could expect to earn perhaps £60,000 a year in the UK. Before they left for Cape Town, my woman constituent was earning £26,000 a year as a pub manager. As she has been out of work for two years in Cape Town, however, there is a gap in her CV, so she is unlikely to be able to walk straight back into a manager’s position, although she aspires to do so in a couple of years’ time. Wages in the pub trade are not particularly high, so it is likely she will start on a salary below £18,600. As I said, they would have a joint income as a family of about £75,000 because her husband could get a well-paid job, but under the new rules it is based on her income, so he would not be able to join her.

Fiona Mactaggart: My hon. Friend cites a number of cases. I think this whole process is unfair because it is quite clear that families who can afford to maintain themselves without making any demands on public funds are being kept apart. My hon. Friend has cases of people returning to the UK, and just this week I have had two constituents contact me about similar issues. One case was a man returning here from India who has £82,000 in a UK bank. Clearly, he and his wife could properly maintain themselves. However, savings do not count. The man is self-employed, but will not have the long record of employment needed to meet the £26,000-plus requirement, so he is unable to have his wife here with him. The other person—

Nigel Evans: I am sorry to interrupt the hon. Lady, but this is supposed to be an intervention, not a speech.

Kerry McCarthy: Perhaps when I have spoken for a little longer, my hon. Friend the Member for Slough (Fiona Mactaggart) will be able to intervene again and make her second point. Indeed, if she intervenes several more times, she may eventually be able to tell the whole story.
	I understand that those who earn less than £18,600 can top it up if they have savings, up to a maximum of £62,000. A constituent who was in that situation came to see me the other day. Perhaps the Minister will be able to clarify the position when he responds, but I think that people have to show that they have had the money in their accounts for six months and it has not just been lent to them.
	The final case to which I want to refer is that of a constituent whose girlfriend is based in Hong Kong, but is of Philippine origin. He wants her to join him in the United Kingdom, but they cannot marry. She was married to an abusive husband in the Philippines—she fled to Hong Kong to get away from him—but divorce is illegal in the Philippines, which in itself raises interesting questions. What happens if someone from the Philippines comes to this country and wants to marry a British citizen? What will be the impact on that person’s immigration status if that is not allowed?
	The couple cannot live in the Philippines together, which is an option that they explored. If my constituent were in a relationship with an undivorced woman in the Philippines, he could face seven years in jail and she could face three to four years.
	It turned out, after we had looked into it, that my constituent’s income is just enough for him to qualify under the rules. He came to see me because he had heard about the £62,000 savings limit, and thought that he was expected to have that much money in the bank on top of his income. However, if he had earned just £100 a month less, he would not have been able to bring his partner to the United Kingdom either. They were exploring the possible options. His partner was considering going to Canada, and he thought that perhaps he would be able to join her there.
	The situation is ridiculous. My constituent has family responsibilities, and is settled in employment in the UK. The fact that he would have been forced to go to the other side of the world to be with his partner when she could join him here seems nonsensical to me.

Virendra Sharma: Does my hon. Friend agree that the rules go against the basic principle that families should be united rather than divided? These financial conditions are dividing not only husbands and wives but parents, grandparents and others. Are they not unfair and discriminatory, especially to those outside European Union countries?

Kerry McCarthy: I think that the Government are trying to avoid circumstances in which spouses or fiancées, for instance, are used as a form of chain migration. I have seen that happen, and I accept that the system is open to abuse and should not be abused in that way. I have come across instances in which people first apply for permission for a spouse to join them in this country, and then extend the application to elderly parents, or perhaps younger brothers and sisters. I accept that we have to manage migration to this country, and that we ought to control such situations. However, none of the cases I have cited involves anything like that.
	People are increasingly working and studying abroad. People are going off to university in other countries, meeting their partners there, and then not being able to return to the United Kingdom with their partners until they have established themselves on the career ladder. It is not uncommon now for graduates to start work—if they can start work; they may be on unpaid or paid internships or low-paid jobs for the first couple of years after graduating—but to be unable to bring their partners into this country. I recognise the need to ensure that new migrants to the UK do not increase the burden on the British taxpayer, but many couples survive on less than the average income without being a burden on the taxpayer.

Fiona Mactaggart: The earning capacity of the spouse from overseas cannot be taken into account. I received a tragic e-mail today from a man who wrote “I cannot get the money. I fell in love with my wife. What can I do? I am really scared.” His wife speaks fluent English, and is a qualified science teacher in Algeria. She would have been able to contribute to science education in my constituency, but she is not going to be able to come here.

Kerry McCarthy: That is a valid point and I was about to come on to it. Why is this based only on the sponsor’s salary? As I mentioned, it is highly likely the couple currently living in Cape Town would have a joint income of £75,000 or more, so they would not in any way be a burden on the state.
	Basing things solely on the sponsor’s income will inevitably have a differential impact on women who seek to bring their partner here, because, sadly, it is still a fact of life that women are likely to earn less than their partner. Of course, this is even more likely when a child is involved. If a couple wish to return to the UK because the woman is about to give birth—which means she will not be working for the next year or so—they will not be able to do so, even if the man has an offer of a well-paid job here, unless he meets the increasingly stringent rules for getting a work visa, which would mean he would have to work in a specific field where there is a skills shortage.
	I want to make a point about flexibility, too. In the current economic climate, people can lose their jobs at the drop of a hat, and these rules do not deal with the realities of life. People can be earning a decent income one day but not the next day, and then be back in work a month or two later. How can the rules be sufficiently flexible to deal with such situations, rather than just penalise people?
	What representations has the Minister received about cases that fall into this category? From the research I have done, it is clear there are many such cases. Stories have been reported in the newspapers, too, and many MPs have constituents who are caught up in this situation. What analysis has the Minister done of the sort of people caught under these new rules, and in the light of some of the human stories he has heard—stories of couples who simply want to be able to spend their lives together in the UK—has he given any consideration to revising the rules and allowing more flexibility in decision making?

Mark Harper: I am grateful to the hon. Member for Bristol East (Kerry McCarthy) for giving me an opportunity to set out the Government’s thinking. As she was speaking, I was thinking through a number of responses, and I hope I can also respond to the multiple instalment story from the hon. Member for Slough (Fiona Mactaggart), who finally got it all out, I think.
	Let me first set out a bit of background to put this matter in context. As part of our general reform of the immigration system across all the routes coming to the United Kingdom, we undertook a major overhaul of the family routes. There were three aims: to prevent burdens on the taxpayer, to promote integration, and to tackle abuse. The hon. Member for Bristol East’s focus has been on the financial requirement, which is the minimum income threshold of £18,600 a year to be met by those wishing to sponsor a partner of non-European economic area nationality to settle in the UK, with higher levels for those who also sponsor dependent non-EEA national children.
	The point of the requirement is to prevent burdens from falling on the taxpayer and to promote successful integration. To put the story round the other way and to
	throw it back at the hon. Lady and the hon. Member for Ealing, Southall (Mr Sharma), people can come here to establish their family lives, but we ask that they should not expect the taxpayer to fund that.
	The hon. Lady raised the point about no recourse to public funds, which has always been in place, and suggested that was a sufficient protection for the taxpayer. The problem with that is twofold. First, under the immigration rules only some things the taxpayer funds are classed as public funds. The things that are not considered as public funds are NHS costs, social care, contribution-based jobseeker’s allowance, incapacity benefit, maternity allowance, retirement pension and statutory maternity pay. A range of funds, therefore, are not excluded under the no recourse to public funds measure. If someone comes to the UK under no recourse to public funds, we would still have to provide health care to them, therefore, which may well be a burden on the taxpayer.

Fiona Mactaggart: Most of the benefits to which the Minister has referred are contribution-based, and therefore are not relevant. On health care, however, I think most of our constituents would be quite happy if there were a requirement looking at some way of paying for health care, because part of the point of this is that there are lots of cases where people will have enough money on any system, but not on this rule.

Mark Harper: Let me come back to that. The specific cases that the hon. Lady and the hon. Member for Bristol East raised can I think be dealt with elsewhere in the immigration rules; that comes back to the point about representations.

Kerry McCarthy: It seems to me wrong that if someone is earning a modest income, their partner or child cannot access the NHS, but if they are wealthy, they can. Surely that goes completely against what the NHS is meant to be about. The Minister is saying that there is a different rule for people who earn more, meaning that their partners can get NHS treatment.

Mark Harper: No, the hon. Lady misunderstands me, which I am sure is my fault for not explaining the situation. The point is that if someone comes here and we say they have no recourse to public funds, they do have access to the NHS. I think the hon. Lady was arguing that because someone on a modest income who brings their family member here could not access public funds, that would not place a burden on the taxpayer. My point was that if, for example, that person needed to access the NHS, they could, and of course that burden would fall on the taxpayer, even though the income-earner’s contribution to the Exchequer may be very modest.
	The other, wider, issue concerns the way our welfare system works. The presence of the partner may of course increase the benefits that the British national is entitled to. Although the migrant might not be entitled to housing benefit, for example, their presence may well increase the amount that the UK citizen is able to claim. That may give rise to a genuine issue about how our welfare system works—that is another debate—but given how it works, it is not quite as simple as saying that, because there is no recourse to public funds, there is no burden on the taxpayer from their presence.
	I want to say something about a change relating to integration, albeit briefly as it does not fall within the category of finance. We think English language skills are very important, which is why, from October, we are increasing the level of English language skills we expect. That is partly to give those who come here the best possible chance of integrating—participating in the workplace and being part of the community.

Neil Carmichael: The Minister is making a really important point. People are welcome, providing they can contribute to the society they are joining. That is surely good for them, too. Does the Minister agree that the central point regarding language and income is that they feel comfortable, involved and included?

Mark Harper: I do, and that goes back to the central point of the debate.
	I was about to give a little background to how we arrived at the particular sums of money involved, because that is helpful—

Fiona Mactaggart: Will the Minister take this opportunity to commit to making sure that in every country, applicants who are trying to come here to join a spouse can actually get the qualifications he is going to require of them?

Mark Harper: My understanding is that people are able to do that. I can tell from the way the hon. Lady is looking at me that there is a point behind her question, so if she will do me the courtesy of dropping me a line, I will examine the argument she is making and get back to her, rather than diverting the debate away from its central point.

Julian Lewis: At the risk of diverting the debate for just a fraction longer, I worry a bit about this language test. I come from a third-generation immigrant family, and my grandfather to the end of his life spoke English haltingly and with a thick foreign accent. What mattered was that he was able to undertake a productive trade, and that his children and grandchildren were not cosseted by being taught in the language of the country they had left, but were properly educated in the language of the country they had joined. To have too stringent a language test is to look at the problem the wrong way round.

Mark Harper: I was listening very carefully to what my hon. Friend said, and I will reflect on it. I thank him for making that point.
	Let me say a little more about the financial changes—

Therese Coffey: I am glad that my hon. Friend is moving on to that point, because residents in my constituency are surprised that the limit of £18,000 is so low, given that we hear concerns about the benefits cap of £26,000. I am delighted that he is going to explain why the limit is £18,000—of course, it is more for people with children.

Mark Harper: The previous requirement, which I think has been alluded to, was that applicants had to be “adequately maintained”. The courts generally interpreted
	that to mean income equivalent to the level of income support for a British family of that size, which was about £5,500 a year for a couple at that time. Our view was that that level of income was not an adequate basis for sustainable family migration and did not provide adequate assurance that UK sponsors and their migrant partners could support themselves and their children over the long term.
	The previous regime also required quite a complex assessment, both for applicants and caseworkers, of current and prospective employment income and other financial means. It made decision making difficult, as was highlighted by the independent chief inspector’s report of 24 January on the processing of applications under the old rules for spouses and partners. Again, that was partly why we wanted a financial requirement that was clear and transparent; applicants would know where they stood, and we could make clear and timely decisions.
	The minimum income threshold is £18,600 a year, with a higher amount with those sponsoring dependent children—it is £22,400 for those sponsoring one child and an extra £2,400 for each further child. We based that on the expert advice of the independent Migration Advisory Committee. It gave us a range of figures and that was at the low end. Its figures went up to about £25,000, a level at which someone would be making a net contribution to the Exchequer. The £18,600 level we settled on is broadly the income at which a couple, once settled here, cannot access income-related benefits. It is not an exact match, but it was as close as we can get. Our approach broadly says, “If they are here earning that amount of money, they are going to be able to stand on their own two feet and not expect the taxpayer to support them.”

Kate Green: I understand the logic the Minister is outlining, but when benefits are assessed for a household they are assessed on a household basis. So this approach does not appear to address the point that has been made about ignoring the income of the incoming spouse.

Mark Harper: The hon. Lady makes a very good point, which I am coming on to address. In most cases—this comes back to the point about representations—including one of the cases the hon. Member for Bristol East raised and the one mentioned by the hon. Member for Slough (Fiona Mactaggart), there is often an alternative way, through the immigration rules, of someone getting to the United Kingdom. So the reason we do not take into account—

Kerry McCarthy: rose—

Mark Harper: Let me just develop the point, because either I will answer it satisfactorily or I will not and the hon. Lady will then be able pick up the point she thinks I have not answered adequately, rather than getting in first. I will make two points. First, we do not take into account the previous income of the migrant partner when they apply for entry clearance mainly because what someone happened to be earning elsewhere is no guarantee of their finding work here. However, in the case she highlighted of the female British citizen with a South African husband and in the case that the hon. Member for Slough mentioned of the skilled science
	teacher, although the partner may not be able to get entry clearance to come to the United Kingdom as a spouse, they would of course be able to apply under our tier 2 skilled working visa to come to the United Kingdom. They could then get entry clearance on that basis and once here in work, earning an income, they would be able to switch into the family route. They could then show that they could earn that level of income and that would then be taken into account. So people who would be able to come here to work in a skilled job could come here under an alternative route and once they have established the fact of earning that level of income, they would be able to change their status under the spouse route, with the appropriate route to settlement. So certainly the South African husband could follow that route and it would work for him.

Kerry McCarthy: My understanding is that he would be able to do that only if his job could not be filled by a UK person. He is a computer programmer and, obviously, there are a lot of those in this country already, so he would not meet the criteria: no employer would say that the skills they required could be met only by him and not by anyone else. He has worked in the UK for six years under a work permit and it was unfortunate that the couple left the UK for a short time and the rules changed while they were out of the country. Had they not done so, they would have been able to go down the route that the Minister suggested.

Mark Harper: Under the tier 2 rule, it has to be a skilled job and they have to undergo a resident labour market test. So if he has a particular employer in mind, the rules may be a little more inflexible in the sense that he may not be able to say a specific employer, but if he has skills to offer, there are many occupations in which there is a shortage of people. If it is an occupation on the shortage occupation list, the employer is not required to undergo a resident labour market test. There are therefore opportunities in certain cases for someone to come here.
	The hon. Member for Slough highlighted the issue of savings. Despite the fact that I managed to throw together some maths A-levels, that was a long time ago so I will not try to do the maths in my head. Savings can be used to make up the difference. We look at the amount of savings above £16,000, which is the threshold that is generally disregarded for income-related benefits. If someone holds savings for the period that they are hoping to come to the United Kingdom, which would be 30 months, the savings count as long as the applicants have them under their control for at least six months.

Fiona Mactaggart: Even if they are self-employed?

Mark Harper: I believe that the answer is yes. If inspiration does not strike me before the end of the debate to confirm that, I will write to her.
	In the immigration rules laid today, we have made some changes to the evidential requirements. For example, we had cases in which people were in receipt of tax-free stipends from universities. The net amount was below £18,600 and the rules were previously unclear about whether people could gross it up. I had a couple of cases raised with me and I thought it self-evident that people should be able to gross it up. So we have made it clear that that is indeed the case.

Therese Coffey: Does my hon. Friend agree that plenty of companies in this country regularly secure permits to bring talented people to fulfil specific roles? So, it happens now and we are proud to welcome talent into our country to fill those roles.

Mark Harper: My hon. Friend is right. If people have married or are with a partner, they are looking at a particular route. It is worth saying, and her intervention highlights this, that there are alternative routes for people under the immigration rules for some of these difficult cases.

Neil Carmichael: May I go back to the qualification period, for both savings and income? Why did the Government choose six months?

Mark Harper: It was to ensure that people could not abuse the system by holding the money for only a day or two, making the application, succeeding and then giving the money back. It is to make sure that the money is genuinely under someone’s control and available to them rather than their borrowing money that belongs to someone else for a short period. We felt that six months met that requirement without being overly burdensome and putting unreasonable requirements on individuals.
	Perhaps I will follow up the point made by the hon. Member for Slough if she speaks to me about the specific case. Inspiration has told me that the savings do not count in that way with self-employed people. If she has a specific case, which it looks like she has, perhaps she will draw that to my attention and I will look at it and see whether I think the rules are sufficient to deal with it.

Thomas Docherty: I beg to move, That the House sit in private.
	Question put forthwith (Standing Order No. 163)
	The House proceeded to a Division.

Paul Flynn: On a point of order, Mr Deputy Speaker, the Division seems to be taking an excessively long time.

Nigel Evans: I am sorry, I did not hear the hon. Gentleman.

Paul Flynn: My point of order was about the length of time the Division is taking given the small number of Members present. Are people playing games?

Mr Deputy Speaker: Mr Flynn, I cannot believe that that could possibly happen. If somebody is playing games, I am not sure who it is. You made your point of order just as I was rising to ask the Serjeant at Arms to investigate the delay in both Lobbies.

Mr Deputy Speaker: I am on the verge of sending somebody to see where the Serjeant at Arms has gone. Has this got anything to do with Comic Relief by any chance? It is that time of year.

Mark Harper: Comic Relief is tomorrow.

Mr Deputy Speaker: We may still be sitting tomorrow!
	The House having divided:

Ayes 3, Noes 82.

Question accordingly negatived.

Thomas Docherty: On a point of order, Mr Deputy Speaker. There is some confusion over whether it is technically possible under “Erskine May” to call for a Division on the Adjournment. Of course, you are the gatekeeper and the guardian of good order, but my understanding is that there have been occasions on which the House has divided on the Adjournment. I believe that after an Adjournment debate on Norway in 1940, there was a Division on the Adjournment. Any guidance that you can give me would be gratefully received.

Mr Deputy Speaker: I thank the hon. Gentleman for his point of order. I know that the House is waiting with eager anticipation for the answer. The answer is that it is gone 5.30, so the Question would not be put in any event. Therefore, the Question cannot be put.

Thomas Docherty: Further to that point of order, Mr Deputy Speaker. I am incredibly grateful for that clarification. I had a brief opportunity in the few moments that I spent in the Aye Lobby to look at “Erskine May”, but I could not find that reference. Is it possible for it to be circulated, for the benefit of Members such as me who are not as knowledgeable as Mr Deputy Speaker, so that we do not waste any more of the House’s time?

Mr Deputy Speaker: Some people may interpret what is going on now as being a waste of time, but certainly not the Chair. I am absolutely certain that clarifications on the rules of procedure will be made. The Question could have been put before the moment of interruption, for instance at 5.29, which, as the hon. Gentleman has pointed out, has happened in the past. I think that the last time it happened was in the 1970s. On this occasion, we have clearly gone past the moment of interruption and, therefore, the Question will not be posed.

Jacob Rees-Mogg: On a point of order, Mr Deputy Speaker. If the Question that this House do now adjourn cannot be put, how can we decide whether the House is to adjourn or not? Surely if we have missed the opportunity for putting that Question, we need to carry on sitting.

Mr Deputy Speaker: Thank you, Mr Rees-Mogg, for that point of order. We are past the moment of interruption. Had the Minister carried on speaking until half past 5, I would have just stood up and not put the Question.
	House adjourned without Question put (Standing Order No. 9(7)).